0920-0770 Attachment 2c Behavioral Assessment (IDU) English versio

Attachment 2c
Behavioral Assessment IDU (Enlgish) Form Approved:
OMB No. 0920-0770
Expiration Date: XX/XX/XXXX

National HIV Behavioral Surveillance System: Core Questionnaire
IDU Cycle
Public reporting burden of this collection of information is estimated to average 54 minutes per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining
the data needed, and completing and reviewing the collection of information. An agency may not conduct
or sponsor, and a person is not required to respond to a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of
this collection of information, including suggestions for reducing this burden to: CDC, Project Clearance
Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0770). Do not send the
completed form to this address.

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National HIV Behavioral Surveillance System: Core Questionnaire
AUTO7.

Time core questionnaire began: __ __:__ __ : __ __ [Military time HH:MM:SS]

NHBS-MSM Core Intro:
SAY: “Most people have never been in an interview like this one, so I’m going to describe how it
works before we start. I will read you questions exactly as they are written. Some may sound
awkward but I need to read them as worded so everyone in the study is asked the same questions.
Some questions will ask you to recall if you did something, when you did it, or how often you
did it. For others, I’ll read or show you a list of responses to choose from. Please be as accurate
as you can.”
Go to Say Box before DM-1

NHBS-IDU Core Intro:
SAY: “Most people have never been in an interview like this one, so I’m going to describe how it
works before we start. I will read you questions exactly as they are written. Some may sound
awkward but I need to read them as worded so everyone in the study is asked the same questions.
Some questions will ask you to recall if you did something, when you did it, or how often you
did it. For others, I’ll read or show you a list of responses to choose from. Please be as accurate
as you can.”
If R is NOT a seed (INT10=0), SAY:
“I'm going to start by asking you about the person who gave you this coupon and about other
people you know in [project area] who inject. Please remember that your answers will be kept
private.” [Go to NS-1.]
Else, if R IS a seed (INT10=1), Go to NS-2

NHBS-HET Core Intro:
SAY: “Most people have never been in an interview like this one, so I’m going to describe how
it works before we start. I will read you questions exactly as they are written. Some may sound
awkward but I need to read them as worded so everyone in the study is asked the same
questions. Some questions will ask you to recall if you did something, when you did it, or how
often you did it. For others, I’ll read or show you a list of responses to choose from. Please be
as accurate as you can.”
If R is NOT a seed (INT10=0), SAY:
“I'm going to start by asking you about the person who gave you this coupon and about other
people you know in [Response to INT2] who you are close to. Please remember that your
answers will be kept private.” [Go to NS-1a.]
Else, if R IS a seed (INT10=1), Go to NS-3
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Recruiter Relationship, NHBS-IDU
NS-1.

[GIVE RESPONDENT FLASHCARD B.1.] Which of the following describes how you
know the person who gave you this coupon? You can choose more than one answer. [READ
CHOICES. CHECK ALL THAT APPLY.]

1
A person you have sex with............................................  2
A person you use drugs with or buy drugs from ………  3
A friend…………………………………………………  4
A relative or family member ……….….……................

An acquaintance (that is, a person you know,

5
A stranger (you don’t know the person/just met them… 6
Refused to answer……………………………………… 77
but do not consider a friend)…………….………...

If NS-1 ≠ 6, go to NS-2. Else, go to CONF4.

Recruiter Relationship, NHBS-HET
NS-1a.

[GIVE RESPONDENT FLASHCARD B.2.] Which of the following describes how you
know the person who gave you this coupon? You can choose more than one answer. [READ
CHOICES. CHECK ALL THAT APPLY.]

1
A person you have sex with.............................................  2
A friend ……...................................................................  3
A relative or family member…………………...............

An acquaintance (that is, a person you know,

4
A stranger (you don’t know the person/just met them… 5
Refused to answer……………………………………… 77
but do not consider a friend)…………….………...

If NS-1a ≠ 5, go to NS-3. Else, go to CONF4.
CONF4. Confirmation Message if recruiter = stranger:
IF NS-1 = 6 or NS-1a=5,
Where and when did you first see this person?
Interviewer:
If the respondent indicates that they first saw the recruiter in a situation related to the project (e.g.
receiving their coupon, waiting outside the storefront, etc.), then check “Recruiter is a stranger.”
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Recruiter is a stranger…………1 If NHBS-IDU, go to NS-2. If NHBS-HET, go to NS-3.
Recruiter is not a stranger……..2 If NHBS-IDU, go to NS-1 and enter relationship.
If NHBS-HET, go to NS-1a and enter relationship.

Network Size – NHBS-IDU
NS-2.

How many people in [insert project area] do you know who inject? (By ‘know,’ I mean you
know their name OR you see them around even if you don’t know their name.)
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If NS-2 > 3 AND NS-2 < 7777:
If NS-2 = 0:
If NS-2 > 0 AND NS-2 < 4:
If NS-2 = 7777 or 9999:

Go to NS-2a.
Go to CONF5.
Go to CONF6.
Skip to Say Box before DM-1

CONF5.
If overall network size is 0 (NS-2 = 0),
ASK: “You said you don’t know anyone in [project area] who injects. Is this correct? By ‘know,’ I
mean you know their name OR you see them around even if you don’t know their name.”
If “NO” (R DOES know other injectors):
go back to NS-2 (ask it again)
If “YES” (R does NOT know any other injector): go to Say Box before DM-1
CONF6.
If overall network size is 1 – 3 (NS-2 = 1, 2, OR 3)
ASK: “Is there anyone else you know in [project area] who injects? By ‘know,’ I mean you know
their name OR you see them around even if you don’t know their name.”
If ‘NO,’ (respondent does NOT know any other injectors):
If ‘YES’, (respondent DOES know more injectors):

Go to Logic Check before NS-2a
Go back to NS-2
-Ask it again, if needed
-Enter the correct network size.
-Then go to Logic Check before
NS-2a.

If confirmed overall network size = 1, skip to NS-2d.

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NS-2a.

Of the ________[insert number from NS-2] people who live in [insert project area] and you
know inject, how many have you seen at least once in the past 30 days? (Again, by “know,” I
mean you know their name OR you see them around, even if you don’t know their name.)
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

If NS-2a = 0:
Otherwise:

Go to CONF7.
Go to logic check before NS-2b.

CONF7. If R has seen NO injectors he knows in past 30 days (NS-2 = 0),
ASK: “You said you don’t know anyone in [project area] who injects and who you’ve seen at least
once in the past 30 days. Is this correct? Remember, by ‘know,’ I mean you know their name OR you
see them around even if you don’t know their name.”
If “NO” (respondent has seen an injector):
If “YES” (respondent has NOT seen an injector):

Go back to NS-2a
-Enter the correct network size.
-Then, go to Logic check before NS-2b
Go to Say Box before DM-1

If NS-2a is (0, 7777, or 9999), skip to Say Box before DM-1.
If NS-2a = 1, skip to NS-2e.

NS-2b.

Of the ________[insert number from NS-2a] people who inject that you have seen in the
past 30 days, how many are male?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

CONF8. If NS-2b = NS-2a,
SAY: “So, all the people you know who inject and that you have seen in the past 30 days are
male?”
If correct, go to SAY Box before DM-1.
If NOT correct, display interviewer instruction:
SAY: “Please confirm the number of people you know who inject, who are at least 18 years old, live
in [project area], and that you have seen in the past 30 days.”
Then, go to NS-2a.
NS-2c.

Of the ________[insert number from NS-2a] people who inject that you have seen in the
past 30 days, how many are female?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

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Skip to SAY Box before DM-1.
Single IDU Known
NS-2d.
Have you seen this person at least once in the past 30 days?
No………….……………………………………  0

1
Refused to answer…………....…………………  7
Don't know…………………………..…………  9
Yes……………………………………………..

NS-2e.

Is this person male or female?
Male….…………………………………………  1
Female…………………………………………..  2

7
Don't know….……………………..……………  9
Refused to answer…....………………………

Skip to Say Box before DM-1.

Network Size – NHBS-HET
NS-3.

Please tell me how many friends, relatives or people you are close to who are at least 18 years
old, and live in [project area]. [GIVE RESPONDENT FLASHCARD C.]
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

IF NS-3 > 3 AND NS-3 < 7777:
IF NS-3 = 0:
IF NS-3 > 0 AND NS-3 < 4:
If NS-3 = 7777 or 9999:

Go to NS-3a.
Go to CONF9.
Go to CONF10.
Skip to Say Box before DM-1

CONF9. Confirmation Message if overall network size = 0:
IF NS-3 = 0,
ASK: “You said you don’t have ANY friends, relatives, or people you are close to who are at least 18
years old and live in [project area]. Is this correct?”
If ‘No’:
If ‘Yes’:

(DOES know someone)
(Does NOT know someone)

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go back to NS-3 (ask it again)
go to Say Box before DM-1.

20

CONF10. Confirmation Message if overall network size = 1, 2, or 3:
IF NS-3 = 1, 2, OR 3
ASK: “Do you have ANY OTHER friends, relatives, or people you are close to who are at least 18
years old and live in [project area]?
If ‘NO,’:

Go to Logic Check before NS-3a

If ‘YES’:

Go back to NS-3
-Ask it again, if needed
-Enter the correct network size.
-Then, go to Logic Check before NS-3a.

If confirmed overall network size = 1, skip to NS-3d.

NS-3a.

Of those ________[insert number from NS-3] people, how many have you seen at least once
in the past 30 days?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

IF NS-3a = 0:
Otherwise:

Go to CONF11.
Go to logic check before NS-3b.

CONF11.
Confirmation Message if Recent Network = 0:
IF NS-3a = 0,
ASK: “You said that in the past 30 days, you haven’t seen ANY of the friends, relatives, or people you
are close to in [project area]. Is this correct?”
If NO:

Go back to NS-3a
-Enter the correct network size.
-Then, go to Logic check before NS-3b.

If YES:

Go to Say box before DM-1.

If NS-3a is (0, 7777, or 9999), skip to the Say box before DM-1.
If NS-3a = 1, skip to NS-3e.

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NS-3b.

Of the ________[insert number from NS3a] people that you are close to and have seen in the
past 30 days, how many are male?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

CONF 12.
If NS-3b= NS-3a
SAY: “So, all the friends, relatives, or people you are close to who are at least 18 years old, who
live in [insert project area] and you have seen in the past 30 days are male?”
If correct, go to Say box before DM-1.
If NOT correct, display interviewer instruction:
SAY: “Please confirm the number of friends, relatives or people you are close to who are at least 18
years old, live in [project area], and that you have seen in the past 30 days.”
Then, go to NS-3a.

NS3c.

Of the ________[insert number from NS-3a] people that you are close to and have seen in
the past 30 days, how many are female?
[Refused= 7777, Don’t Know= 9999] ___ ___ ___

Skip to Say Box before DM-1.

Single HET Known
NS-3d.

Have you seen this person at least once in the past 30 days?
No……………………………………………
Yes…………………………………………...
Refused to answer……....……………………
Don't know……………………..……………

NS-3e.

0
1
7
9

Is this person male or female?
Male……………………………………………
Female………………………………………...
Refused to answer……....……………………
Don't know……………………..……………

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1
2
7
9
22

National HIV Behavioral Surveillance System: Core Questionnaire

_______________________________________________________
Demographics (DM)
SAY: [If NHBS-MSM, insert “I’d like to start by asking”; otherwise, insert “Next, I’d like to ask
you”] some questions about where you live. Please remember your answers will be kept private.”
DM-1.

In the past 12 months, have you been homeless at any time? By homeless, I mean you were
living on the street, in a shelter, in a Single Room Occupancy hotel (SRO) , or in a car.

0
Yes……………………………………………  1
Refused to answer.……………………………  7
Don't know……………..……………………….  9
No.………………….…………………………

If NHBS-MSM or NHBS-IDU and DM-1 in (0, 7, 9), skip to DM-2.
If NHBS-HET and DM-1 in (0, 7, 9), skip to DM-3.
DM-1a.

Are you currently homeless?

0
Yes….……………………………….……........  1
Refused to answer………………………..…….  7
Don't know.……………..………………..........  9
No………………….……………….………….

If NHBS-HET, skip to DM-3.
DM-2.

DM-3.

What zip code do you live in?
[Refused = 77777, Don't know = 99999]

__ __ __ __ __

Next, I would like to ask you some questions about your background. What country were you
born in? [DO NOT read choices. Check only ONE.]

1
Mexico….………………….………….……….  2
Puerto Rico..……………….………….……….  3
Cuba…….………………….………….……….  4
Other (Specify_________________)………...  5
Refused to answer………………………….…..  77
Don't know…….………………………….….....  99

United States….………………….………….

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For NHBS-MSM:
If DM-3 in (1, 77, 99), skip to DM-5.
If CITY= San Juan, PR, and DM3=3, skip to DM-5.
For NHBS-IDU and NHBS-HET:
If DM-3 in (1, 77, 99), skip to DM-4.
If CITY= San Juan, PR, and DM3=3, skip to DM-4.
DM-3a.

What year did you first come to live in the United States?
[7777 = Refused, 9999 = Don't know]

__ __ __ __
(Y

DM-3b.

Y

Y

Y)

What language are you most comfortable using with your family and friends? [DO NOT READ
CHOICES. CHECK ONLY ONE.]
English....................................................................................  1
Spanish ...................................................................................  2
Chinese............................................................................. 3
Tagalog ............................................................................ 4
Korean ....................................................................................  5
Portuguese..............................................................................  6
Other (Specify:__________________________) ............  7
Refused to answer .................................................................  77
Don’t know ............................................................................  99

For NHBS-MSM, skip to DM-5
For NHBS-IDU AND NHBS-HET, ask DM-4 through DM-4a
DM-4.

[GIVE RESPONDENT FLASHCARD D.] What is your current marital status?
[READ CHOICES. CHECK only ONE.]

1
Living together as married……………………... 2
Separated…….……….…………………..…….. 3
Divorced…….…….…………………..……….. 4
Widowed….………..…………………………... 5
Never married……...………..………………… 6
Refused to answer……………………………  7
Don't know…..……………..……………….....  9
Married……...…………………………………

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If DM-4= 2, ask DM-4a. Otherwise, skip to DM-5.
DM-a. Is your formal marital status separated, divorced, widowed, or never married?
Separated…….……….…………………..…….. 1
Divorced…….…….…………………..……….. 2
Widowed….………..…………………………... 3

4
Refused to answer………………………………  7
Don't know….……………..……………….......  9
Never married……...………..………………

DM-5.

What is the highest level of education you completed?
[DO NOT read choices. Check only ONE.]
Never attended school….………………………….
Grades 1 through 8….…………………...………..
Grades 9 through 11..…………………….…….….
Grades 12 or GED...….……..…..…………………
Some college, Associate’s Degree, or Technical Degree…….
Bachelor’s Degree..………….…………….………
Any post graduate studies ………….…………….
Refused to answer………………..………………..
Don't know……..………………..………………..

DM-6.

 00
 01
 02
 03
 04
 05
 06
 77
 99

What best describes your employment status? Are you: [READ CHOICES. CHECK only
ONE.]

 01
Employed part-time…………………………………………  02
A homemaker….……….…………………...……………….  03
A full-time student…….…….………………………………  04
Retired….………..……………………………......................  05
Unable to work for health reasons…………………. ……….  06
Unemployed………..………………………….......................  07
Other………..…………………………..................................  08
Refused to answer………………………..……………………  77
Don't know.……………..………………...................................  99

Employed full-time………………….……………………….

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For Respondents who are not currently homeless (DM-1=0 OR DM-1a=0): Say: Next I'd like to ask
you some questions about your household income. By "household income," I mean the total amount of
money earned and shared by all people living in your household.
For Respondents who are currently homeless (DM-1a=1):
Say: Next I'd like to ask you some questions about your income. By "income," I mean the total amount
of money you earn or receive. This includes money other people share with you.

DM-7.

What was your [insert household income if DM-1=0 OR DM-1a=0; insert income if DM1a=1] last year from all sources before taxes?
GIVE RESPONDENT FLASHCARD E. DO NOT read choices.

SAY: Please take a look at this card and tell me the letter that best corresponds to your monthly or
yearly income.
Monthly Income

Yearly Income

a. 0 to $417……………...a. 0 to $4,999……………….  00
b. $418 to $833………… b. $5,000 to $9,999………..  01

 02
d. $1042 to $1250……….d. $12,500 to $14,999…….  03
e. $1251 to $1667.……... e. $15,000 to $19,999……..  04
f. $1668 to $2082………. f. $20,000 to $24,999……..  05
g. $2083 to $2500……… g. $25,000 to $29,999……..  06
h. $2501 to $2916………..h. $30,000 to $34,999……..  07
i $2917 to $3333……… i. $35,000 to $39,999……..  08
j. $3334 to $4167………. j. $40,000 to $49,999……..  09
k. $4168 to $4999………. k. $50,000 to $59,999……..  10
l. $5000 to $6,250……… l. $60,000 to $74,999..…..  11
m. $6251 or more……….. m. $75,000 or more………  12
Refused to answer………. ………………………………. 77
Don't know……..………………………………………..... 99
c. $834 to $1041……… c. $10,000 to $12,499..…

DM-7a.

Skip to DM-8

Including yourself, how many people depended on this income? [MUST BE AT LEAST 1.]
[Refused = 77, Don't know = 99]

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26

SAY: The next questions are about health insurance. By health insurance, we mean health plans people
get through employment or purchased directly as well as government programs like Medicare
and Medicaid that provide medical care or help pay medical bills.

DM-8.

Do you currently have health insurance or health care coverage?
No………………….…………………………… 0 Skip to DM-8b
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

DM-8a.

9

Skip to DM-8b

[Give participant Flashcard F.] What kind of health insurance or coverage do you currently
have? [READ choices. Check ALL that apply.]

 01
Medicaid / [local Medicaid name] (for people with low incomes).………………..…  02
Medicare (for the elderly and people with disabilities)……….…………………..……  03
Some other government plan / [local non-Medicaid name]…………………………  04
TRICARE (CHAMPUS)……………………………...……….….………..…………..  05
Veterans Administration coverage……………………………..………..………..……  06
Some other health care plan…………….……………………………...……….………  07
A private health plan (through an employer or purchased directly) ……………..……

(Specify______________________________)

 77
Don't know……..………………………………………..……………..………………  99
Refused to answer……………………………………..……….………………………

DM-8b.

Is there a place that you usually go when you are sick or you need advice about your health?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

If DM-8b=1, 7, or 9, skip to DM-8c.

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DM-8b.1. Is this because there is no place you go for health care or because there is more than one place?

1
There is more than one place…………………  2
Refused to answer………………………………  7
Don't know………………..……………………  9
There is no place………………….……………

If DM-8b.1 =1, 7, or 9, skip to DM-9.

DM-8c.

What kind of place [if DM-8b=1, fill “is it?”; else fill “do you go to most often”] - a clinic,
doctor's office, emergency room, or some other place?

1
Doctor's office or HMO………………….……  2
Hospital emergency room………………….….  3
Some other place………………….…………  4
Doesn’t go to one place most often.…………  5
Refused to answer………………………………  7
Don't know……………..………………………  9
Clinic or health center………………….……

Skip to DM-9.

DM-9.

Have you seen a doctor, nurse, or other health care provider in the past 12 months?
No………………….…………………………… 0 Skip to DM-9b
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

DM-9a.

9

Skip to DM-9b

At any of those times you were seen, were you offered an HIV test? An HIV test checks
whether someone has the virus that causes AIDS.
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

Skip to DM-9c.

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DM-9b.

About how long has it been since you last saw a doctor, nurse, or other health care provider
about your own health? Would you say it was…[READ CHOICES. CHECK ONLY ONE.]
Within the past 5 years…..…………………..…  1
More than 5 years ago……………………..…....  2

7
Don't know………………..……………………  9
Refused to answer……………………………

DM-9c.

During the past 12 months, was there any time when you needed medical care but didn't get it
because you couldn't afford it?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

DM-10.

9

Do you consider yourself to be: [READ CHOICES. CHECK ONLY ONE.]
Heterosexual or "Straight"…………….……......  1
Homosexual, Gay, or Lesbian………………….  2

3
Refused to answer…………………..………….  7
Don’t know................……………………….….  9

Bisexual………………………………………..

If DM-10 in (1, 7, 9), skip to DM-11.
If Respondent is male (ES9=1), ask DM-10a. Otherwise, skip to Say Box before SX-1.

DM-10a. Have you ever told anyone that you are attracted to or have sex with men?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

If DM-10a in (0, 7, 9), skip to DM-11.

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DM-10b. I'm going to read you a list of people you may have told. Please tell me which ones apply.
Have you told: [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]
No

Yes

Refused Does not
to answer Apply

Don’t
know

 0… 1….. 7….  8 ….  9
2. Friends who are not gay, lesbian, or bisexual………  0… 1….  7….  8….  9
3. Family members……………………………………  0… 1….  7….  8….  9
1. Gay, lesbian, or bisexual friends …... ……………

FOR NHBS-IDU AND NHBS-HET: ASK DM-10b.4
4. Spouse or partner…………………………………..
5. Health care provider……………………………….
DM-11 .

 0… 1….. 7….  8….  9
 0… 1….. 7….  8….  9

During the past 12 months, have any of the following things happened to you because someone
knew or assumed you were attracted to men? [READ CHOICES, CHECK NO OR YES FOR
EACH ONE.]
No

Yes

Refused
to
answer

0

1

7

9

0

1

7

9

0

1

7

0

1

7

0

1

7

a. You were called names or insulted
b. You received poorer services than other people in
restaurants, stores, other businesses or agencies
c. You were treated unfairly at work or school
d. You were denied or given lower quality health care
e. You were physically attacked or injured

DM-12.

Does
not
apply

8
8

Don’t
know

9
9
9

Next, I’m going to read you a statement. Please tell me how strongly you agree or disagree with
it, using one of the options on this card. [Give participant Flashcard G.]
Most people in [project area] are tolerant of gays and bisexuals. Do you…[Read choices.
Mark only one.]
Strongly agree……………......……..………………….
Agree…………………………….……….....................
Neither agree nor disagree……..…..………….............
Disagree…………………………………………….…
Strongly disagree……… …..………..…….….............
Refused to answer………………………………….…
Don’t know……..……… …..………..…….….............

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

 01
 02
 03
 04
 05
 07
 09
30

SEXUAL BEHAVIOR (SX)
If NHBS-MSM and ES9a in (0, 7, 9), skip to SAY Box before SX-26.
SAY: Next, I'm going to ask you some questions about having sex. Please remember your answers
will be kept private. GIVE RESPONDENT FLASHCARD H.1
For these questions, "having sex" means oral, vaginal, or anal sex. Oral sex means mouth on the
vagina or penis; vaginal sex means penis in the vagina; and anal sex means penis in the anus (butt). I
need to ask you all the questions, even if some may not apply to your situation.
Interviewer: Use your discretion in using slang terms for the following sexual behavior questions.

INTERVIEWER INSTRUCTIONS: Refer to response to Gender Question (ES9).
Male

For NHBS-MSM, go to logic check before SX-2
FOR NHBS-IDU, GO TO SX-1
FOR NHBS-HET, GO TO SX-2.

Female

FOR NHBS-IDU, GO TO SX-54
FOR NHBS-HET, GO TO SX-55

Transgender or Gender unknown

FOR ALL CYCLES, GO TO SAY BOX
BEFORE AL-1

FOR MALE RESPONDENTS ONLY
Female Sex Partners (Male respondent)
SX-1.

Have you ever had vaginal or anal sex with a woman?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

If SX-1 in (0, 7, 9), skip to SX-26.
If NHBS-MSM and ES9a in (0, 7, 9), skip to SAY Box before SX-26.
SX-2.

How old were you the first time you had vaginal or anal sex with a woman?
[77 = Refused, 99 = Don't know, 88=Not Applicable]

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

__ __

31

If SX-2=88, skip to CONF13a.
CONF13a. Het sex confirmation – male participants
If SX-2=88, display:
“Interviewer, you have indicated that the participant has never had vaginal or anal sex with a
woman. Is this correct?”
No………………….……………………………  0
Yes……………………………………………...  1
If No, go back to SX-2.
If Yes and NHBS-HET, skip to END of Questionnaire.
If Yes and NHBS-MSM or NHBS-IDU, skip to Say Box before SX-26.
SX-3.

In the past 12 months, that is, since  of last year, with how many different
women have you had oral, vaginal, or anal sex?
[Refused = 7777, Don't know = 9999]
___ ___ ____ ____

NHBS-MSM & NHBS-IDU Skip Pattern for # of Female Sex Partners:
If SX-3 =1:
Ask SX-4a. (RT column)
If SX-3 > 1:
Ask SX-4. (LT column)
If SX-3 = 0, 7777, or 9999: Go to SAY Box before SX-26
NHBS-HET Skip Pattern for # of Female Sex Partners:
If SX-3 =1:
Ask SX-4a. (RT column)
If SX-3 > 1:
Ask SX-4. (LT column)
If SX-3 = 0, 7777, or 9999: Go to CONF13.
CONF-13b. Sex partner confirmation (NHBS-HET):
If SX-3=0, 7777, or 9999, read:
I would like to clarify your response. You indicated that you haven’t had sex with a woman in the past
12 months. Is that correct?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer……………………………...
Don’t know…………………………………...

7
9

If NO (NOT correct), go to SX-3 (ask it again)
If YES, (correct), Refused, or Don’t know, go to END of Questionnaire.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

32

FOR MULTIPLE FEMALE SEX PARTNERS
[Read Say Box and Questions in this column]
SAY: Now I'm going to ask you to describe these sex
partners as either main or casual partners. [GIVE

FOR ONE FEMALE SEX PARTNER
[Read Say Box and Question in this column]
SAY: Now I'm going to ask you to describe this sex
partner as either a main or casual, partner.

RESPONDENT FLASHCARD I]

[GIVE RESPONDENT FLASHCARD I]

By “main partner” I mean a woman you have sex with
and who you feel committed to above anyone else. This
is a partner you would call your girlfriend, wife,
significant other, or life partner. And by “casual partner”
I mean a woman you have sex with but do not feel
committed to or don't know very well.
Refused = 7777, Don't know = 9999

By “main partner” I mean a woman you have sex
with and who you feel committed to above anyone
else. This is a partner you would call your girlfriend,
wife, significant other, or life partner. And by
“casual partner” I mean a woman you have sex with
but do not feel committed to or don't know very well.

Question
SX-4. Of the _____ [insert
number from SX-3]
women you’ve had oral,
vaginal, or anal sex with in
the past 12 months, how
many of them were main
partners?
SX-5. How many were
casual partners?

Response

Skip Pattern

[_____]

If SX-4= SX-3,
skip to Say Box
before SX-6a.

Question

SX 4a. Was this woman a main partner or a casual
partner?

 1 Skip to Say Box before SX-6a
Casual partner…..  2 Skip to Say Box before SX-7a
Refused to answer..7
Main partner……

Skip to SX-8

[_____]

Don't know……….

9

Skip Pattern for Multiple Female Sex Partners:
If SX-4 ≠ 0, 7777, or 9999:
Go to Say Box before SX-6a.
Otherwise, if SX-5 ≠ 0, 7777, or 9999:
Go to Say Box before SX-7a.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

33

MAIN PARTNERS
MULTIPLE MAIN FEMALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999
SAY: Now I'm going to ask you about the _______ [insert
number from SX-4] female main sex partners you had in the
past 12 months.
Question
SX-6a. Of your ______ [insert
number from SX-4] female main
partners in the past 12 months, with
how many did you have vaginal sex?
SX-6b. In the past 12 months, with
how many of these ______ [insert
number from SX-6a] women did
you have vaginal sex without using a
condom?
SX-6c. Of your ______ [insert
number from SX-4] female main
partners in the past 12 months, with
how many did you have anal sex?
SX-6d. In the past 12 months, with
how many of these ______ [insert
number from SX-6c] women did
you have anal sex without using a
condom?
SX6e. Of your ____ [insert number
from SX-4] female main partners,
how many did you have sex with for
the very first time in the past 12
months?

Response

Skip Pattern

[_____]

If 0, 7777, or
9999, skip to
SX-6c.

Question

If 0, 7777, or
9999, skip to
SX-6e.

Response

SX-6a. In the past 12
months, did you have
vaginal sex with this
woman?
SX-6b. In the past 12
months, did you have
vaginal sex with her
without using a condom?

[_____]

[_____]

ONE MAIN FEMALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the female
main sex partner you had in the past 12 months.

SX-6c. In the past 12
months, did you have anal
sex with this woman?

[_____]

Skip
Pattern
If 0, 7, or 9,
skip to SX6c.

[_____]

[_____]

If 0, 7, or 9,
skip to SX6e.

SX 6d. In the past 12
[_____]

[_____]

months, did you have anal
sex with her without using
a condom?
SX-6e. Think about the
very first time you had sex
with this woman. Was it
within the past 12 months?

SX-6f. Of your ______ [insert
number from SX-4] female main
partners in the past 12 months, how
many did you give things like money
or drugs in exchange for sex?

SX-6f. In the past 12
months, did you give this
woman things like money
or drugs in exchange for
sex?

SX-6g. Of your ______ [insert
number from SX-4] female main
partners in the past 12 months, how
many gave you things like money or
drugs in exchange for sex?

SX-6g. In the past 12
months, did this woman
give you things like money
or drugs in exchange for
sex?

[_____]

[_____]

If SX-4a=1,
skip to SX9.

Skip Pattern for Multiple Female Sex Partners:
If SX-4 = SX-3:
Skip to SX-9.
Otherwise, if SX-5 ≠ 0, 7777, or 9999:
Go to Say Box before SX-7a.
NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

34

CASUAL PARTNERS
MULTIPLE CASUAL FEMALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999
SAY: Now I'm going to ask you about the _______ [insert
number from SX-5] female casual sex partners you had in the
past 12 months. Remember, a casual sex partner is someone you
do not feel committed to or don't know very well.
Question
Response Skip Pattern

ONE CASUAL FEMALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the female
casual sex partner you had in the past 12 months.
Remember, a casual sex partner is someone you do
not feel committed to or don't know very well.
Question
Response
Skip Pattern

SX-7a. Of your ______ [insert
number from SX-5] female casual
partners in the past 12 months, with
how many did you have vaginal sex?

[_____]

If 0, 7777, or
9999, skip to
SX-7c.

SX-7a. In the past 12
months, did you have
vaginal sex with this
woman?

[_____]

If 0, 7777, or
9999, skip to
SX-7c.

SX-7b. In the past 12
months, did you have
vaginal sex with her
without using a
condom?
SX-7c. In the past 12
months, did you have
anal sex with this
woman?

SX-7b. In the past 12 months, with
how many of these ______ [insert
number from SX-7a] women did you
have vaginal sex without using a
condom?
SX-7c. Of your ______ [insert
number from SX-5] female causal
partners in the past 12 months, with
how many did you have anal sex?
SX-7d. In the past 12 months, with
how many of these ______ [insert
number from SX-7c] women did you
have anal sex without using a
condom
SX-7e. Of your ____ [insert number
from SX-4] female casual partners,
how many did you have sex with for
the very first time in the past 12
months?
SX-7f. Of your ______ [insert
number from SX-5] female casual
partners in the past 12 months, how
many did you give things like money
or drugs in exchange for sex?
SX-7g. Of your ______ [insert
number from SX-5] female casual
partners in the past 12 months, how
many gave you things like money or
drugs in exchange for sex?

If 0, 7777, or
9999, skip to
SX-7e.

[_____]

[_____]

[_____]

SX-7d. In the past 12
months did you have
anal sex with her
without using a
condom?
SX-7e. Think about the
very first time you had
sex with this woman.
Was it within the past
12 months?
SX-7f. In the past 12
months, did you give
this woman things like
money or drugs in
exchange for sex?
SX-7g. In the past 12
months, did this woman
give you things like
money or drugs in
exchange for sex?

If 0, 7, or 9,
skip to SX-7c

[_____]

[_____]

If 0, 7777, or
9999, skip to
SX-7c.

If 0, 7, or 9,
skip to SX7e.

[_____]

[_____]

[_____]

If SX-4a=2,
skip to SX-9.

If SX-3=1 and SX4a ≠ 7 OR 9, skip to SX-9.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

35

SX-8.

In the past 12 months, did you have vaginal or anal sex without a condom with a woman whose
HIV status you didn't know?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-8a .

9

In the past 12 months did you have vaginal or anal sex without a condom with a woman who
was HIV negative?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-8b .

9

In the past 12 months, did you have vaginal or anal sex without a condom with a woman who
was HIV positive?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-9.

9

Now I would like you to think about the last time you had sex with a woman. When was the
last time you had oral, vaginal, or anal sex with a woman? Just tell me the month and year.
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ _
(M M / Y

Y

Y

Y)

If SX-9 = 77/7777 or 99/9999, go to CONF14.
CONF14. INTERVIEWER, ask:
Did you have sex with a woman in the past 12 months, that is, since &[AGO_1Y]?
No…………………………………………… 0
Yes…………………………………………..  1
Don’t know…………………………………. 9
Refuse to answer……………………………. 7

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

36

Skip Pattern:
If SX-3 =1:
Otherwise, if SX-3 > 1:

SX-10 .

Go to Logic check before SX-11 .
Ask SX-10.

Was the woman you had sex with that last time a main partner or a casual partner? GIVE
RESPONDENT FLASHCARD I. Remember, a main sex partner is someone you feel
committed to above anyone else. And a casual sex partner is someone you do not feel
committed to or don’t know very well.
Main sex partner………......................................  1
Casual sex partner………....................................  2
Refused to answer................................................  7
Don’t know………..............................................  9

If participant had only one female partner and reported NO exchange with only female partner,
skip to SX-12.
If last female partner was main (SX-10=1), and participant reported NO exchange sex with any
female main partners (both SX-6f and SX-6g= 0), skip to SX-12.
If last female partner was casual (SX-10=2) and participant reported NO exchange sex with any
female casual partners (SX-7f and SX-7g = 0), skip to SX-12.

SX-11.

When you had sex that last time, did you give her things like money or drugs in exchange for
sex?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-11a.

9

When you had sex that last time, did she give you things like money or drugs in exchange for
sex?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9

37

SX-12.

When you had sex that last time, did you have vaginal sex?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX13.

9

During vaginal sex that last time, did you or your partner use a condom?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-13a.

9

Did you or your partner use the condom the whole time?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-14.

9

Did you or your partner use the condom to prevent pregnancy, to prevent infections like HIV
or other sexually transmitted diseases, to prevent both, or for some other reason?
Pregnancy ………………….…….….................  1

2
Both….…………………………………………  3
Other reason…………….…….....……………..  4
Refused to answer…………………..…….…….  7
Don't know……………..……………...…........  9
HIV/STDs…………………… ………………..

If participant did not report anal sex with only female partner or did not report anal sex with any
female partners of the type identified for last female partner, skip to SX-17.

SX-15.

When you had sex that last time, did you have anal sex?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9
38

If SX-15 in (0, 7, 9), skip to CONF15.

SX-16.

During anal sex that last time, did you use a condom?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

If SX-16 in (0, 7, 9), skip to SX-17.

SX-16a.

Did you use the condom the whole time?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

CONF-15 Confirmation Message: Ask the following if SX-12 and SX-15 = 0:
"So this means you only had oral sex the last time you had sex?"
If participant says “No,” go back to SX-12.

SX-17.

Before or during the last time you had sex with this partner, did you use:
[READ CHOICES. CHECK only ONE.]

1
Drugs…………………………………………………...  2
Both alcohol and drugs………………………………...  3
Neither one……………………………………………...  4
Refused to answer……...………………………………  7
Don't know…….………………..……………………...  9
Alcohol..………………….……………………………

If SX-17 in (1, 4, 7, 9), skip to SX-18.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

39

SX-17a.

Which drugs did you use? [DO NOT read choices. CHECK ALL that apply.]
Marijuana ….……………..…..…...……….……….
Speedballs (heroin and cocaine together) .…………
Heroin ….……………..…..…...….…………….….
Crack cocaine….……………..…..…...….………...
Powdered cocaine ….……………..…..…...….……
Crystal meth (tina, crank, ice) ….……………..……
X or Ecstasy ….……………..…..…...….………….
Special K (ketamine) ….……………..…..…...….…
GHB ….……………..…..…...….………………….
Painkillers (Oxycontin, Vicodin, Percocet) ….…….
Downers (Valium, Ativan, Xanax) ….…………….
Hallucinogens (LSD, mushrooms) ….……………...
Poppers ….……………..…..…...….………………
Other drug ......................................................……..
Refused to answer…………………..…….…….......
Don't know……………..……………...…..............

SX-18.

1
2
3
4
5
6
7
8
9
 10
 11
 12
 13
 14
 77
 99

The last time you had sex with this partner, did you know her HIV status?
No………………….……………………………  0 Skip toSX-19
Yes……………………………………………...  1
Refused to answer………………………………  7 Skip to SX-19

SX-18a.

What was her HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..………..  2
Indeterminate……………………………..…….  3
Refused to answer.……………………………...  7

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

40

SX-19.

Was this partner younger than you, older than you, or the same age as you?
Younger ….……………..…..…...….………………
Older ….……………..…..…...….………………
Same age ….……………..…..…...….………………
Refused to answer…………………..…….…….......
Don't know……………..……………...…..............

0
1
2
7
9

If SX-19 in (0, 2, 7, 9), skip to SX-20.

SX-19a.

What was her age?

___ ___ ___

[777 = Refused, 999 = Don't know]

SX-19b . Which of the following best describes her racial or ethnic background? [READ choices.
Choose one.]
American Indian or Alaska Native..……………  1

2
Black or African American ……………..……..  3
Hispanic or Latino……………………………… 4
Native Hawaiian or Other Pacific Islander…….  5
White….……………..…………………………  6
Refused to answer………………………………  7
Don’t know.……………………………………  9
Asian .……………………..……………….......

SX-20.

As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?
Would you say she: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
2
3
7
9

41

SX-21.

As far as you know, has this partner ever used crack cocaine?
Would you say she: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-22.

1
2
3
7
9

As far as you know, has this partner ever been in prison or jail for more than 24 hours?
Would you say she: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-23.

1
2
3
7
9

How long have you been having a sexual relationship with this partner? (Please tell me how
many days, months, or years). [Interviewer: If “one night stand,” enter 0]
# of Days:

__ __ __

# of Months: __ __ __
# of Years:

__ __ __

[Refused = 777, Don't know = 999]
If SX-23 > 12 months, skip to SX-25
If SX-23=0, skip to Say box before SX-26.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

42

SX-24.

As far as you know, during the time you were having a sexual relationship with this partner,
did she have sex with other people? Would you say she: [READ CHOICES. Check only
ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-24a.

1
2
3
7
9

During the time you were having a sexual relationship with this partner, did you have sex with
other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

9

If SX-23 ≤ 12 months, skip to SX-26
SX-25.

As far as you know, during the past 12 months when you were having a sexual relationship
with this partner, did she have sex with other people? Would you say she: [READ
CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-25a.

1
2
3
7
9

During the past 12 months when you were having a sexual relationship with this partner, did
you have sex with other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9
43

Male Sex Partners (Male respondent)
SAY: Now I'm going to ask you some questions about having sex with other men. I need to ask you
these questions even if some don't apply to you. Please remember your answers will be kept private.
[GIVE RESPONDENT FLASHCARD H.2]
For these questions, "having sex" means oral or anal sex. Oral sex means he put his mouth on your
penis or you put your mouth on his penis. Anal sex means you put your penis in his anus (butt) or he
put his penis in your anus (butt).
If NHBS-MSM, skip to SX-27.
SX-26.

Have you ever had oral or anal sex with a man?
No………………….………….………………..  0

Skip to Say Box before AL-1

Yes………………………………..………….....  1
Refused to answer……………………………
Don't know……………..………….………......
SX-27.

7
9

Skip to Say Box before AL-1

How old were you the first time you had oral or anal sex with a man?
[77 = Refused, 99 = Don't know, 88=Not Applicable]
__ __

If SX-27=88, skip to CONF15b.
CONF15b. MSM sex confirmation
If SX-27=88, display: “Interviewer, you have indicated that the participant said he never had
either oral or anal sex with a man. Is this correct?”
No………………….……………………………  0
Yes……………………………………………...  1
If No, go back to SX-27.
If Yes and NHBS-MSM, skip to END of Questionnaire.
If Yes and NHBS-IDU or NHBS-HET, skip to Say Box before AL-1.
SX-28.

In the past 12 months, that is, since  of last year, with how many different men
have you had oral or anal sex?
[Refused = 7777, Don't know = 9999]

___ ___ ___ ___

If SX-28 ≥ 1 and SX-28 < 7777, skip to SX-29.
If SX-28 = 0, ask SX-28a, then skip to SX-50.
SX-28a.

Think about the last time you had either oral or anal sex with a man. How many years ago was
that?
[Refused = 7777, Don't know = 9999]
___ ___ ___ ___ Range: 1 – 99

Skip Pattern for # of Male Sexual Partners: If SX-28 =1, ask SX-29a.
Otherwise, ask SX-29.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

44

FOR MULTIPLE MALE PARTNERS
[Read Say Box and Questions in this column]
SAY: Now I'm going to ask you to describe these sex
partners as either main or casual partners.

FOR ONE MALE PARTNER
[Read Say Box and Question in this column]
SAY: Now I'm going to ask you to describe this sex
partner as either main or casual partners.

[GIVE RESPONDENT FLASHCARD J]

[GIVE RESPONDENT FLASHCARD J]

By “main partner” I mean a man you have sex with and
who you feel committed to above anyone else. This is a
partner you would call your boyfriend, husband,
significant other, or life partner. And by “casual partner” I
mean a man you have sex with but do not feel committed
to or don't know very well.

By “main partner” I mean a man you have sex with
and who you feel committed to above anyone else.
This is a partner you would call your boyfriend,
husband, significant other, or life partner. And by
“casual partner” I mean a man you have sex with
but do not feel committed to or don't know very
well.

Refused = 7777, Don't know = 9999
Question
Response

SX-29. Of the _____ [insert
number from SX-28] men
you’ve had oral or anal sex with
in the past 12 months, how
many of them were main
partners?
SX-30. How many were casual
partners?

[_____]

Skip
Pattern
If SX-29 =
SX-28, skip
to Say Box
before SX31a.

Question

SX-29a. Was this man a main partner or a casual
partner?

1
Casual partner…...... 2
Refused to answer.... 7
Don’t know..…….. ... 9

Main partner……....
[_____]

Skip to SX-31a
Skip to SX-32a

Skip to SX-33

Skip Pattern For Multiple Male Partners:
If SX-29 is not equal to 0, 7777, or 9999, go to Say Box before SX31a.
Otherwise, if SX-30 is not equal to 0, 7777, or 9999, go to Say Box before SX-32a.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

45

MAIN MALE PARTNERS
MULTIPLE MAIN MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999

SAY: Now I'm going to ask you about the _______ [insert
number from SX-29] male main sex partners you had in the
past 12 months.
Question

SX-31a. Of your ______
[insert number from SX-29]
male main partners in the past
12 months, with how many
did you have anal sex?

SX-31b.3. Of those ___
[insert number from SX31b.2] men, how many did
you know were HIV-positive?
SX-31b.4. How many did you
know were HIV-negative?
Soft edit check
SX-31c. Of your ____ [insert
number from SX-29] male
main partners, how many did
you have sex with for the
very first time in the past 12
months?

SAY: Now I'm going to ask you about the male
main sex partner you had in the past 12 months.

Response

Skip Pattern

Question

[_____]

If 0, 7777, or
9999, skip to SX31c.

SX-31a. In the
past 12 months,
did you have anal
sex with this man?

SX-31b. In the past 12
months, with how many of
these ______ [insert number
from SX-31a] men did you
have anal sex without using a
condom?
SX-31b.1. Did you know the
HIV status of any of these
___ [insert number from SX31b] men?
SX-31b.2. For how many of
these men did you know their
HIV status?

ONE MAIN MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9

Response

[_____]

Skip Pattern
If 0, 7, or 9,
skip to SX31c.

SX-31b. In the
[_____]

0 = no
1 = yes
7 = Ref

[_____]

If 0 or 7, skip to
SX-31c

If 1, ask single
partner version of
SX-31b.2, then go
to SX-31c.

past 12 months,
did you have anal
sex with him
without using a
condom?
SX-31b.1. Did
you know his HIV
status?

SX-31b.2. What
was his HIV
status?

[_____]

0 = no
1 = yes
7 = Ref

If 0 or 7, skip
to SX-31c

HIV-positive…1
HIV-negative…2
Indeterminate…3
Refused……….7

[_____]

[_____]

[_____]

SX-31d. Of your ______
[insert number from SX-29]
male main partners in the past
12 months, how many did
you give things like money or
drugs in exchange for sex?

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

SX-31c.
Think about the
very first time you
had sex with this
man. Was it
within the past 12
months?
SX-31d. In the
past 12 months,
did you give this
man things like
money or drugs in
exchange for sex?

[_____]

46

MULTIPLE MAIN MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999

SX-31e. Of your ______
[insert number from SX-29]
male main partners in the past
12 months, how many gave
you things like money or
drugs in exchange for sex?

ONE MAIN MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9
If SX-29a=1,
SX-31e. In the
skip to QSXpast 12 months,
33.
did this man give

you things like
money or drugs, in
exchange for sex?

Skip Pattern for Multiple Male Sex Partners:
If SX-29= SX-28, Skip to SX-33.
Otherwise, if SX-30 is not equal to 0, 7777, or 9999, go to Say Box before SX-32a.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

47

CASUAL PARTNERS
MULTIPLE CASUAL MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999
SAY: Now I'm going to ask you about the _______ [insert
number from SX-30] male casual sex partners you had in
the past 12 months. Remember, a casual sex partner is
someone you do not feel committed to or don't know very
well.
Question
Response Skip Pattern

ONE CASUAL MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9
SAY: Now I'm going to ask you about the male
casual sex partner you had in the past 12 months.
Remember, a casual sex partner is someone you
do not feel committed to or don't know very well.

SX-32a. Of your ______ [insert
number fromSX-30] male
casual partners in the past 12
months, with how many did you
have anal sex?

SX-32a. In the
past 12 months,
did you have
anal sex with
this man?

SX-32b. In the past 12 months,
with how many of these ______
[insert number from SX-32a]
men did you have anal sex
without using a condom?
SX-32b.1. Did you know the
HIV status of any of these ___
[insert number from SX-32b]
men?

[_____]

[_____]

0 = no
1 = yes
7 = Ref

SX-32b.2. For how many of
these men did you know their
HIV status?

[_____]

SX-32b.3. Of those ___ [insert
number from SX-32b.2] men,
how many did you know were
HIV-positive?

[_____]

SX-32b.4. How many did you
know were HIV-negative?
Soft edit check
SX-32c. Of your ____ [insert
number from SX-30] male
casual partners, how many did
you have sex with for the very
first time in the past 12 months?

If 0, 7777, or
9999, skip to
SX-32c.

If 0 or 7, skip
toSX-32c.

If 1, ask single
partner
version of SX32b.2, then go
to SX-32c.

Question

SX-32b. In the
past 12 months,
did you have
anal sex without
using a condom?
SX-32b.1. Did
you know his
HIV status?
SX-32b.2. What
was his HIV
status?

Response

Skip Pattern

[_____]

If 0, 7, or 9,
skip to SX32c.

[_____]

0 = no
1 = yes
7 = Ref

If 0 or 7, skip
to SX-32c.

HIV-positive…1
HIV-negative…2
Indeterminate…3
Refused……….7

[_____]

[_____]

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

SX-32c. Think
about the very
first time you
had sex with this
man. Was it
within the past
12 months?

[____]

48

MULTIPLE CASUAL MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999
SX-32d. Of your ______ [insert
number from SX-30] male
casual partners in the past 12
months, how many did you give
things like money or drugs in
exchange for sex?
SX-32e. Of your ______ [insert
number from SX-30] male
casual partners in the past 12
months, how many gave you
things like money or drugs in
exchange for sex?

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

ONE CASUAL MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9
SX-32d. In the
past 12 months,
did you give this
man things like
money or drugs
in exchange for
sex?
SX-32e. In the
past 12 months,
did this man
give you things
like money or
drugs, in
exchange for
sex?

49

SX-33.

Now I would like you to think about the last time you had sex with a man. When was the last
time you had anal or oral sex with a man? Just tell me the month and year.
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ _
(M M / Y

Y

Y

Y)

If SX-33 = 77/7777 or 99/9999, go to CONF16.
CONF16. INTERVIEWER:
Did you have sex with a man in the past 12 months, that is, since &[AGO_1Y]?
No…………………………………………… 0
Yes…………………………………………..  1
Don’t know…………………………………. 9
Refuse to answer……………………………. 7
Skip Pattern:
If SX-28=1, go to SX-35.
Otherwise, if SX-28>1, ask SX-34.
SX-34.

Was the man you had sex with that last time a main partner or a casual partner? GIVE
RESPONDENT FLASHCARD I. Remember, a main sex partner is someone you feel
committed to above anyone else. And a casual sex partner is someone you do not feel
committed to or don’t know very well.
Main sex partner………......................................  1
Casual sex partner………....................................  2
Refused to answer................................................  7
Don’t know………..............................................  9

If participant had one male partner and reported NO exchange with only male partner, skip to SX-36.
If last male partner = main (SX-34 = 1) AND participant reported NO exchange with ANY male main
partners, skip to SX-36.
If last male partner = casual (SX-34 = 2) and participant reported NO exchange with ANY male casual
partners, skip to SX-36.
SX-35.

When you had sex that last time, did you give him things like money or drugs in exchange for
sex?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9

50

SX-35a.

When you had sex that last time, did he give you things like money or drugs in exchange for
sex?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-36.

9

When you had sex that last time, did you have receptive anal sex where he put his penis in
your anus (butt)?
No………………….……………………………  0

Skip to SX-38

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...

SX-37.

9

Skip to SX-38

During receptive anal sex that last time, did he use a condom?
No………………….…………………………… 0

Skip to SX-38

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know……………..……………………...
SX-37a.

9

Skip to SX-38

Did he use the condom the whole time?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-38.

9

When you had sex that last time, did you have insertive anal sex where you put your penis in
his anus (butt)?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-38 in (0, 7, 9), skip to CONF17.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

51

SX-39.

During insertive anal sex that last time, did you use a condom?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-39 in (0, 7, 9), skip to SX-40.

SX-39a.

Did you use the condom the whole time?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

CONF17: Ask the following if SX-36 and SX-38 =0:
"So this means you only had oral sex the last time you had sex?"

SX-40.

Before or during the last time you had sex with this partner, did you use:
[READ CHOICES. CHECK only ONE.]

1
Drugs…………………………………………………...  2
Both alcohol and drugs………………………………...  3
Neither one……………………………………………...  4
Refused to answer……...………………………………  7
Don't know…….………………..……………………...  9

Alcohol..………………….……………………………

If SX-40 in (1, 4, 7, 9), skip to SX-41.

SX-40a.

Which drugs did you use? [DO NOT read choices. Check ALL that apply.]
Marijuana ….……………..…..…...……….……….
Speedballs (heroin and cocaine together) .…………
Heroin ….……………..…..…...….…………….….
Crack cocaine….……………..…..…...….………...
Powdered cocaine ….……………..…..…...….……
Crystal meth (tina, crank, ice) ….……………..……

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
2
3
4
5
6
52

X or Ecstasy ….……………..…..…...….………….
Special K (ketamine) ….……………..…..…...….…
GHB ….……………..…..…...….………………….
Painkillers (Oxycontin, Vicodin, Percocet) ….…….
Downers (Valium, Ativan, Xanax) ….…………….
Hallucinogens (LSD, mushrooms) ….……………...
Poppers ….……………..…..…...….………………
Other drug ......................................................……..
Refused to answer…………………..…….…….......
Don't know……………..……………...…..............

7
8
9
 10
 11
 12
 13
 14
 77
 99

If participant had one male sex partner in past 12 months, skip to SX-42.

SX-41.

The last time you had sex with this partner, did you know his HIV status?
No………………….……………………………  0 Skip to SX-42
Yes……………………………………………...  1
Refused to answer………………………………  7 Skip to SX-42

SX-41a.

What was his HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..………..  2
Indeterminate……………………………..…….  3

Refused to answer.……………………………...  7
SX-42.

Was this partner younger than you, older than you, or the same age as you?
Younger ….….……………..…..…...….………………  0

1
Same age …….……………..…..…...….………………  2
Refused to answer….…………………..…….…….......  7
Don't know…………………..……………...…..............  9
Older ……….……………..…..…...….………………

If SX-42 in (0, 2, 7, 9), skip to SX-43.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

53

___ ___ ___

[777 = Refused, 999 = Don't know]

SX-42a.

What was his age?

SX-42b.

Which of the following best describes his racial or ethnic background? [READ choices.
Choose one.]
American Indian or Alaska Native..……………  1

2
Black or African American ……………..……..  3
Hispanic or Latino……………………………… 4
Native Hawaiian or Other Pacific Islander…….  5
White….……………..…………………………  6
Refused to answer………………………………  7
Don’t know.……………………………………  9
Asian .……………………..……………….......

SX-43.

As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-44.

1
2
3
7
9

As far as you know, has this partner ever used crack cocaine?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
2
3
7
9

54

SX-44a.

As far as you know, has this partner ever used crystal meth (tina, crank, ice)?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-45.

1
2
3
7
9

As far as you know, has this partner ever been in prison or jail for more than 24 hours?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-46.

1
2
3
7
9

How long have you been having a sexual relationship with this partner? (Please tell me how
many days, months, or years). [Interviewer: If “one night stand,” enter 0.]
# of Days:

__ __ __

# of Months: __ __ __
# of Years:

__ __ __

[Refused = 777, Don't know = 999]
If SX-46 > 12 months, 777, or 999, skip to SX-48. If SX-46=0, skip to SX-49.
SX-47.

As far as you know, during the time you were having a sexual relationship with this partner,
did he have sex with other people? Would you say he: [READ CHOICES. Check only
ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
2
3
7
9
55

SX-47a.

During the time you were having a sexual relationship with this partner, did you have sex with
other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-46≤ 12 months, skip to SX-50.
SX-48.

As far as you know, during the past 12 months when you were having a sexual relationship
with this partner, did he have sex with other people? Would you say he: [READ CHOICES.
Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-48a.

1
2
3
7
9

During the past 12 months when you were having a sexual relationship with this partner, did
you have sex with other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-46> or = 3 years or SX-46= Don’t Know or Refused, skip to SX-50

SX-49.

Where did you first meet this partner? [DO NOT read choices. Check only ONE.]

 01
Chat line….….................................................  02
Bar/Club..………….............................………...  03
Circuit party or Rave….......................…………. 04
Cruising area.………….........................……….  05
Adult bookstore…..…............................……….. 06
Bath house, sex club or sex resort….....……….  07
Internet…….....….………………..……………

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

56

Private sex party……...........................………… 08
Somewhere else.................................…………..  09
Refused to answer…………..….……………….  77
Don't know…..………..……..…………….......

 99

If NHBS-IDU OR NHBS-HET, skip to SX-52

SX-50.

In the past 12 months, how often have you gone to a place where gay men hangout, meet or
socialize? These could include bars, clubs, social organizations, parks, gay businesses,
bookstores, sex clubs, etc. Was it: [GIVE RESPONDENT FLASHCARD K. READ
CHOICES. CHECK only ONE.]

Never More than
once a day

Once a
day

More than
once a week

Once
a week

More than
once a month

Once a
a month

Less than
once a month

Refused

Don’t

to answer Know

 0........ 1……..... 2 .……….. 3……..…. 4..…...… 5……..….. 6.…….… 7…….…77…….. ..99
SX-51.

Never

In the past 12 months, how often have you used the internet to meet or socialize with gay men
either for friendship or sex? These could include social network websites (such as Facebook or
MySpace), websites directed towards gay men (such as Manhunt or Gay.com), dating websites,
or the use of mobile social applications (such as Foursquare or Grindr). Was it: [GIVE
RESPONDENT FLASHCARD K. READ CHOICES. CHECK only ONE.]
More than
once a day

Once a
day

More than
once a week

Once
a week

More than
once a month

Once a
a month

Less than
once a month

Refused

Don’t

to answer Know

 0........ 1……..... 2 .……….. 3……..…. 4..…... 5……..…….. 6.…….… 7…….… 77……..99
Skip Pattern: If DM-10 (Sexual identity)=1, ask SX-52.
Otherwise, go to Say Box before AL-1.

SX-52. The next question is about whether you have told people that you are attracted to or have sex
with men. Have you ever told anyone that you are attracted to or have sex with men?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-52 in (0, 7, 9), skip to SX-53.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

57

SX-52a. I'm going to read you a list of people you may have told. Please tell me which ones apply.
Have you told: [READ CHOICES, CHECK NO OR YES FOR EACH ONE.]
No

Yes

Refused Does not
to answer Apply

Don’t
know

 0… 1….. 7….  8 ….  9
2. Friends who are not gay, lesbian, or bisexual………  0… 1….  7….  8….  9
3. Family members……………………………………  0… 1….  7….  8….  9
1. Gay, lesbian, or bisexual friends …... ……………

FOR NHBS-IDU AND NHBS-HET: ASK SX-52a.4

4. Spouse or partner…………………………………..
5. Health care provider……………………………….

SX-53.

 0… 1….. 7….  8….  9
 0… 1….. 7….  8….  9

During the past 12 months, have any of the following things happened to you because someone
knew or assumed you were attracted to men? [READ CHOICES, CHECK NO OR YES FOR
EACH ONE.]

a. You were called names or insulted
b. You received poorer services than other people in
restaurants, stores, other businesses or agencies
c. You were treated unfairly at work or school
d. You were denied or given lower quality health care
e. You were physically attacked or injured

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

No

Yes

Refused
to
answer

Does
not
apply

0

1

7

9

0

1

7

9

0

1

7

0

1

7

0

1

7

8
8

Don’t
know

9
9
9

58

SX-53f.

Next, I’m going to read you a statement. Please tell me how strongly you agree or disagree with
it, using one of the options on this card. [Give participant Flashcard G.]
Most people in [project area] are tolerant of gays and bisexuals. Do you…[Read choices.
Mark only one.]
Strongly agree……………......……..………………….
Agree…………………………….……….....................
Neither agree nor disagree……..…..………….............
Disagree…………………………………………….…
Strongly disagree……… …..………..…….….............
Refused to answer………………………………….…
Don’t know……..……… …..………..…….….............

 01
 02
 03
 04
 05
 07
 09

END OF MALE RESPONDENT SECTION. GO TO SAY BOX BEFORE AL-1.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

59

FOR FEMALE RESPONDENTS ONLY
Male Sex Partners (Female respondent)
SX-54.

Have you ever had vaginal or anal sex with a man?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If SX-54 in (0, 7, 9), skip to SX-80.

SX-55.

How old were you the first time you had vaginal or anal sex with a man?
[77 = Refused, 99 = Don't know; 88 = Not Applicable]

__ __

If SX-55=88, skip to CONF13a.
CONF16b. Het sex confirmation-female participants
If SX-55=88, display:
“Interviewer, you have indicated that the participant has never had either vaginal or anal sex
with a man. Is this correct?”
No………………….……………………………  0
Yes……………………………………………...  1
If No, go back to SX-55.
If Yes and NHBS-HET, skip to END of Questionnaire.
If Yes and NHBS-MSM or NHBS-IDU, skip to Say Box before AL-1.

SX-56.

In the past 12 months, that is, since  of last year, with how many different
men have you had oral, vaginal, or anal sex?
___ ___ ____ ____

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

[Refused = 7777, Don't know = 9999]

60

NHBS-IDU Skip Pattern for # of Male Sexual Partners:
If SX-56 =1, ask SX-57a.
If SX-56 >1, ask SX-57.
If 0, 7777, or 9999, skip to SX-80
NHBS-HET Skip Pattern for # of Female Sex Partners:
If SX-56 =1:
Ask SX-57a. (RT column)
If SX-56 > 1:
Ask SX-57. (LT column)
If SX-56 = 0, 7777, or 9999:
Go to CONF18.
CONF18. Sex partner confirmation:
If SX-56=0, 7777, or 9999, read:
I would like to clarify your response. You indicated that you haven’t had sex with a man in the past 12 month
Is that correct?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer……………………………...  7
Don’t know………..…………………………...  9
If NO (NOT correct), go to SX-56 (ask it again)
If YES, (correct), Refused to answer, or Don’t know, go to End of Questionnaire.
.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

61

FOR MULTIPLE MALE PARTNERS
[Read Say Box and Questions in this column]
SAY: Now I'm going to ask you to describe the sex
partners you've had in the past 12 months as either main or
casual partners.

FOR ONE MALE PARTNER
[Read Say Box and Question in this column]
SAY: Now I'm going to ask you to describe this sex
partner you've had in the past 12 months as either a main
or casual partner.

[GIVE RESPONDENT FLASHCARD J]

[GIVE RESPONDENT FLASHCARD J]

By “main partner” I mean a man you have sex with and
who you feel committed to above anyone else. This is a
partner you would call your boyfriend, husband,
significant other, or life partner. And by “casual partner” I
mean a man you have sex with but do not feel committed
to or don't know very well.
Refused = 7777, Don't know = 9999
Question
Response
Skip
Pattern
If SX-57=
SX-57. Of the _____ [insert
SX-56, skip
number from SX-56] men
you’ve had oral, vaginal, or anal [_____] to Say Box
before SXsex with in the past 12 months,
59a.
how many of them were main
partners?
SX-58. How many were casual
[_____]
partners?

By “main partner” I mean a man you have sex with and
who you feel committed to above anyone else. This is a
partner you would call your boyfriend, husband,
significant other, or life partner. And by “casual partner” I
mean a man you have sex with but do not feel committed
to or don't know very well.
Question

SX-57a. Was this man a main partner or a casual partner?

1
Casual partner…..... 2

Main partner……. ..

Skip to Say Box before SX-59a
Skip to Say Box before SX-60a

7

Refused to answer...

9

Skip to SX-61

Don’t know…….. ...

Skip Pattern for Multiple Male Partners:
If SX-57 is not equal to 0, 7777, or 9999, go to Say Box before SX-59a.
Otherwise, if SX-58 is not equal to 0, 7777, or 9999, go to Say Box before SX-60a.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

62

MAIN MALE PARTNERS
MULTIPLE MAIN MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999

ONE MAIN MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9

SAY: Now I'm going to ask you about the _______ [insert
number from SX-57] male main sex partners you had in the past
12 months.
Question

SX-59a. Of your ______ [insert
number fromSX-57] male main
partners in the past 12 months, with
how many did you have vaginal sex?

Response

Skip Pattern

[_____]

If 0, 7777, or
9999, skip to
SX-59c.

SX-59b. In the past 12 months, with
how many of these ______ [insert
number from SX-59a] men did you
have vaginal sex without using a
condom?

SX-59c. Of your ______ [insert
number fromSX-57] male main
partners in the past 12 months, with
how many did you have anal sex?

SX-59e. Of your ____ [insert
number from SX-57] male main
partners, how many did you have sex
with for the very first time in the past
12 months?
SX-59f. Of your ______ [insert
number from SX-57] male main
partners in the past 12 months, how
many gave you things like money or
drugs in exchange for sex?
SX-59g. Of your ______ [insert
number from SX-57] male main
partners in the past 12 months, how
many did you give things like money
or drugs in exchange for sex?

Question

Response

Skip
Pattern

[_____]

If 0, 7, or
9, skip to
SX-59c.

SX-59a. In the past 12
months, did you have
vaginal sex with this man?

SX-59b. In the past 12
months, did you have
vaginal sex with him
without using a condom?

[_____]

[_____]

SX-59d. With how many of these
______ [insert number from SX59c] men did you have anal sex
without using a condom?

SAY: Now I'm going to ask you about the male main
sex partner you had in the past 12 months.

If 0, 7777, or
9999, skip to
SX-59e.

SX-59c. In the past 12
months, did you have anal
sex with this man?

[_____]

[_____]

If 0, 7, or
9, skip to
SX-59e.

SX-59d. In the past 12
[_____]

months, did you have anal
sex with him without using
a condom?

[_____]

SX-59e. Think about the
[_____]

very first time you had sex
with this man. Was it
within the past 12 months?

[_____]

SX-59f. In the past 12
months, did this man give
you money, drugs, or other
things in exchange for sex?

SX-59g. In the past 12
months, did you give this
man things like money or
drugs in exchange for sex?

If SX57a=1, skip
to SX-62.

Skip Pattern for Multiple Male Sex Partners:
If SX-57= SX-56, go to SX-62.
Otherwise, if SX-58 is not equal to 0, 7777, or 9999, go to Say Box before SX-60a .

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

63

CASUAL PARTNERS
MULTIPLE CASUAL MALE PARTNERS
[Read questions in this column]
Refused = 7777, Don't know = 9999

SAY: Now I'm going to ask you about the _______ [insert
number from SX-58] male casual sex partners you had in the
past 12 months. Remember, a casual sex partner is someone
you do not feel committed to or don't know very well.
Question

SX-60a. Of your ______ [insert
number fromSX-58] male casual
partners in the past 12 months,
with how many did you have
vaginal sex?
SX-60b. In the past 12 months,
with how many of these ______
[insert number from SX-60a]
men did you have vaginal sex
without using a condom?
SX-60c. Of your ______ [insert
number from SX-58] male causal
partners in the past 12 months,
with how many did you have anal
sex?
SX-60d. In the past 12 months,
with how many of these ______
[insert number from SX-60c]
men did you have anal sex
without using a condom?
SX-60e. Of your ____ [insert
number from SX-60] male casual
partners, how many did you have
sex with for the very first time in
the past 12 months?

Response

Skip Pattern

[_____]

If 0, 7777,
or 9999,
skip to SX60c.

SAY: Now I'm going to ask you about the male
casual sex partner you had in the past 12 months.
Remember, a casual sex partner is someone you do
not feel committed to or don't know very well.
Question

SX-60a. In the past 12
months, did you have
vaginal sex with this
man?
SX-60b. In the past 12
months, did you have
vaginal sex with him
without using a
condom?

[_____]

[_____]

ONE CASUAL MALE PARTNER
[Read questions in this column]
No = 0, Yes = 1, Refused = 7, Don't know = 9

If 0, 7777,
or 9999,
skip to SX60e.

Response

Skip Pattern

[_____]

If 0, 7, or 9,
skip to SX60c.

[_____]

SX-60c. In the past 12
months, did you have
anal sex with this man?
[_____]

[_____]

SX-60d. In the past 12
months, did you have
anal sex with him
without a using
condom?

[_____]

[_____]

SX-60e. Think about the
very first time you had
sex with this man. Was
it within the past 12
months?

[_____]

SX-60f. Of your ______ [insert
number fromSX-58] male casual
partners in the past 12 months,
how many gave you things like
money or drugs in exchange for
sex?
SX-60g. Of your ______ [insert
number fromSX-58] male casual
partners in the past 12 months,
how many did you give things
like money or drugs in exchange
for sex?
NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

If 0, 7, or
9, skip to
SX-60e.

SX-60f. In the past 12
months, did this man
give you money, drugs,
or other things in
exchange for sex?
SX-60g. In the past 12
months, did you give
this man things like
money or drugs in
exchange for sex?

64

If SX-56=1 AND SX-57a ≠ 7 OR 9, skip to SX-62.
SX-61.

In the past 12 months, did you have anal or vaginal sex without a condom with a man whose
HIV status you didn't know?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-61a.

9

In the past 12 months did you have vaginal or anal sex without a condom with a man who was
HIV negative?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-61b.

9

In the past 12 months, did you have vaginal or anal sex without a condom with a man who was
HIV positive?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-62.

9

Now I would like you to think about the last time you had sex with a man. When was the
last time you had oral, vaginal, or anal sex with a man? Just tell me the month and year.
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ _
(M M / Y

Y

Y

Y)

If SX-62 = 77/7777 OR 99/9999, go to CONF19.
CONF19. INTERVIEWER:
Did you have sex with a man in the past 12 months, that is, since &[AGO_1Y]?
No…………………………………………… 0
Yes…………………………………………..  1
Don’t know…………………………………. 9
Refuse to answer……………………………. 7
NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

65

If SX-56=1, go to SX-64. Otherwise if SX-56>1, ask SX-63.
SX-63.

Was the man you had sex with that last time a main partner or a casual partner? GIVE
RESPONDENT FLASHCARD J. Remember, a main sex partner is someone you feel
committed to above anyone else. And a casual sex partner is someone you do not feel
committed to or don’t know very well.
Main sex partner………......................................  1
Casual sex partner………....................................  2
Refused to answer................................................  7
Don’t know………..............................................  9

If participant had 1 partner and reported NO exchange with only partner, skip to SX-65.
If participant’s last partner was main partner and participant reported NO exchange with ANY main
partners, skip to SX-65.
If participant’s last partner was casual and participant reported NO exchange with ANY casual
partners, skip to SX-65.
SX-64.

When you had sex that last time, did he give you things like money or drugs in exchange for
sex?
No………………….…………………………… 0

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-64a.

9

When you had sex that last time, did you give him things like money or drugs in exchange for
sex?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-65.

9

When you had sex that last time, did you have vaginal sex?
No………………….……………………………  0

Skip to Logic check before SX-68

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9

Skip to Logic check before SX-68

66

SX-66.

During vaginal sex that last time, did you or your partner use a condom?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-66a.

9

Skip to Logic check before SX-68

Skip to Logic check before SX-68

Did you or your partner use the condom the whole time?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-67.

9

Did you or your partner use the condom to prevent pregnancy, to prevent infections like HIV
or other sexually transmitted diseases, to prevent both, or for some other reason?
Pregnancy ………………….…….…................
HIV/STDs…………………… ………………
Both….………………………………………
Other reason…………….…….....…………….
Refused to answer…………………..…….…
Don't know……………..……………...…........

1
2
3
4
7
9

If participant had 1 male partner and reported NO anal sex with that partner, skip to SX-70.
If participant’s last partner was main and participant reported NO anal sex with ANY main partners,
skip to SX-70.
If participant’s last partner was casual and participant reported NO anal sex with ANY casual
partners, skip to SX-70.

SX-68.

When you had sex that last time, did you have anal sex?
No………………….……………………………  0
Yes……………………………………………...  1

Skip to CONF20.

Refused to answer………………………………  7
Don't know…………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9

Skip to CONF20.

67

SX-69.

During anal sex that last time, did your partner use a condom?
No………………….……………………………  0

Skip to SX-70

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...
SX-69a.

Skip to SX-70

9

Did he use the condom the whole time?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

CONF20. Ask the following if SX-65 and SX-68=0:
"So this means you only had oral sex the last time you had sex?"
If respondent says “no,” go back to SX-65.

SX-70.

Before or during the last time you had sex with this partner, did you use:
[READ CHOICES. CHECK only ONE.]

1
Drugs…………………………………………………...  2
Both alcohol and drugs………………………………...  3
Neither one……………………………………………...  4
Refused to answer……...………………………………  7
Don't know…….………………..……………………...  9
Alcohol..………………….……………………………

SX-70a.

Skip to SX-71

Skip to SX-71.

Which drugs did you use? [DO NOT read choices. Check that apply.]
Marijuana ….……………..…..…...……….……….
Speedballs (heroin and cocaine together) .…………
Heroin ….……………..…..…...….…………….….
Crack cocaine….……………..…..…...….………...
Powdered cocaine ….……………..…..…...….……
Crystal meth (tina, crank, ice) ….……………..……
X or Ecstasy ….……………..…..…...….………….
Special K (ketamine) ….……………..…..…...….…

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
2
3
4
5
6
7
8
68

GHB ….……………..…..…...….………………….
Painkillers (Oxycontin, Vicodin, Percocet) ….…….
Downers (Valium, Ativan, Xanax) ….…………….
Hallucinogens (LSD, mushrooms) ….……………...
Poppers ….……………..…..…...….………………
Other drug ......................................................……..
Refused to answer…………………..…….…….......
Don't know……………..……………...…..............

SX-71.

9
 10
 11
 12
 13
 14
 77
 99

The last time you had sex with this partner, did you know his HIV status?
No………………….……………………………  0

Skip to SX-72

Yes……………………………………………...  1
Refused to answer………………………………  7

SX-71a.

Skip to SX-72

What was his HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..………..  2
Indeterminate……………………………..…….  3
Refused to answer.……………………………...  7

SX-72.

Was this partner younger than you, older than you, or the same age as you?
Younger ….….……………..…..…...….………………  0

1
Same age …….……………..…..…...….………………  2
Refused to answer….…………………..…….…….......  7
Don't know…………………..……………...…..............  9

Skip toSX-73

Older ……….……………..…..…...….………………

SX-72a.

What was his age?

___ ___ ___

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

Skip to SX-73

[777 = Refused, 999 = Don't know]

69

SX-72b.

Which of the following best describes his racial or ethnic background? [READ choices.
Choose one.]
American Indian or Alaska Native..……………  1

2
Black or African American ……………..……..  3
Hispanic or Latino……………………………… 4
Native Hawaiian or Other Pacific Islander…….  5
White….……………..…………………………  6
Refused to answer………………………………  7
Don’t know.……………………………………  9
Asian .……………………..……………….......

SX-73.

As far as you know, has this partner ever injected drugs like heroin, cocaine, or speed?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-74.

1
2
3
7
9

As far as you know, has this partner ever used crack cocaine?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-75.

1
2
3
7
9

As far as you know, has this partner ever been in prison or jail for more than 24 hours?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1
70

Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-76.

2
3
7
9

As far as you know, has this partner ever had sex with other men?
Would you say he: [READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

SX-77.

1
2
3
7
9

How long have you been having a sexual relationship with this partner? (Please tell me how
many days, months, or years). [Interviewer: If “one night stand,” enter 0.]
# of Days:

__ __ __

# of Months: __ __ __
# of Years:

__ __ __

[Refused = 777, Don't know = 999]
If SX-77> 12 months, 777, or 999, skip to SX-79. If SX-77≤ 12 months, skip to SX-80.
If SX-77=0, skip to SX-80.
SX-78.

As far as you know, during the time you were having a sexual relationship with this partner,
did he have sex with other people? Would you say he: [READ CHOICES. Check only
ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

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2
3
7
9

71

SX-78a.

During the time you were having a sexual relationship with this partner, did you have sex with
other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

SX-79.

9

As far as you know, during the past 12 months when you were having a sexual relationship
with this partner, did he have sex with other people? Would you say he: [READ CHOICES.
Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

1
2
3
7
9

SX-79a.During the past 12 months when you were having a sexual relationship with this partner, did you
have sex with other people?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

Female Sex Partners (Female Respondents)
SX-80.

Now I’m going to ask you about having sex with other women. In the past 12 months, with
how many different women have you had sex?
[Refused = 7777, Don't know = 9999] ___ ___ ____ ____

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ALCOHOL USE HISTORY (AL)
SAY: The next questions are about alcohol use. Please remember your answers will be kept private.
For these questions, "a drink of alcohol" means a 12 oz beer, a 5 oz glass of wine, or a 1.5 oz shot of
liquor. SHOW RESPONDENT FLASHCARD L (PICTURE OF ALCOHOL DRINK SIZE)

AL-1.

In the past 12 months, did you drink any alcohol such as beer, wine, malt liquor, or hard
liquor?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

AL-2.

9

Skip to Say Box before ID-1

Skip to Say Box before ID-1

In the past 12 months, how often did you have 5 or more alcoholic drinks in one sitting? [4 or
more drinks if respondent is female.] GIVE RESPONDENT FLASHCARD K. READ
CHOICES. CHECK only ONE.

0
More than once a day…..………………………  1
Once a day……………………………………  2
More than once a week..…………………….....  3
Once a week.…………………………...............  4
More than once a month.……………………….  5
Once a month…..………………………………  6
Less than once a month.…..……………………  7
Refused to answer………………..……………  77
Don’t know...………..…………………………  99
Never….….…………………..………………

AL-3.

The next questions are about drinking alcohol during the past 30 days, that is, since the [insert
day of current month] of last month. During the past 30 days, on how many days did you
drink any alcohol?
[77 = Refused, 99 = Don't know]

__ __

If AL-3 in (0, 77, 99), skip to Say Box before ID-1.

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AL-4. During the past 30 days, on the days when you drank alcohol, how many drinks did you usually
have? (Interviewer: The number of drinks must be greater than 0.)
[77 = Refused, 99 = Don't know]

__ __

AL-5. During the past 30 days, how many times did you have 5 or more alcoholic drinks in one sitting?
[4 or more drinks if respondent is female.]
[77 = Refused, 99 = Don't know]

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74

DRUG USE HISTORY
Injection Drug Use (ID)
SAY: The next questions are about injection drug use. This means injecting drugs yourself or
having someone who isn't a health care provider inject you. Please remember your answers will
be kept private.
FOR NHBS-MSM AND NHBS-HET, ASK ID-1
FOR NHBS-IDU, GO TO ID-1a
ID-1.

Have you ever in your life shot up or injected any drugs other than those prescribed for you?
By shooting up, I mean anytime you might have used drugs with a needle, either by
mainlining, skin popping, or muscling.
No………………….……………………………  0

Skip to Say Box before ND-1

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

ID-1a.

9

Think back to the very first time you injected any drugs, other than those prescribed for you.
How old were you when you first injected any drug?
[77 = Refused, 99 = Don't know]

ID-1b.

Skip to Say Box before ND-1

__ __

When was the last time you injected any drug? That is, how many days or months or years
ago did you last inject?
[Interviewer: If respondent answers today, enter “000” in # of Days field]
# of Days:

__ __ __

# of Months: __ __ __
# of Years:

__ __ __

[Refused = 777, Don't know = 999]
If NHBS-MSM or NHBS-HET and ID-1b > 12 months, skip to Say Box before ND-1.
If NHBS-IDU AND ID-1b> 12 months, skip to END of questionnaire.
SAY: The next questions are about injection drug use in the past 12 months. When I ask you
about "needles," I'm talking about needles and syringes.
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ID-2.

In the past 12 months, on average, how often did you inject? [GIVE RESPONDENT
FLASHCARD K. READ CHOICES. CHOOSE only ONE.]

0
More than once a day…..………………………  1
Once a day….…………………………………  2
More than once a week..…………………….....  3
Once a week…………………………...............  4
More than once a month……………………….  5
Once a month…..………………………………  6
Less than once a month…..……………………  7
Refused to answer………………..……………  77
Don’t know..………..…………………………  99

Never..….….…………………..………………

SAY: I'm going to read you a list of drugs. For each drug I mention, please tell me how often you
injected it in the past 12 months. GIVE RESPONDENT FLASHCARD K
ID-3. How often did you inject… READ EACH DRUG CHOICE. CHOOSE ONLY ONE RESPONSE

ID-3g1.

03
03
03
03
03
03

04
04
04
04
04
04

05
05
05
05
05
05

06
06
06
06
06
06

07
07
07
07
07
07

Did you inject any other drugs in the past 12 months?
No………………….…………………………
Yes……………………………………………
Refused to answer……………………………
Don't know……………..……………………...

0
1
7
9

Skip to SAY box before ID-4

Skip to SAY box before ID-4

Specify other drug _____________________

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76

Refused to
answer

02
02
02
02
02
02

Less than
once a
month

More than
once a
month

01
01
01
01
01
01

Once a
month

Once a
week

00
00
00
00
00
00

More than
once a
week

Speedball (heroin & cocaine together)
Heroin, by itself
Powdered cocaine , by itself
Crack cocaine
Crystal meth (tina, crank, or ice)
Oxycontin

Once a
day

a.
b.
c.
d.
e.
f.

More than
once a day

Never

PER TYPE OF DRUG

77
77
77
77
77
77

ID-3g2.

How often did you inject [Interviewer: insert other drug specified]:

Never

g. (Other drug).

ID-4.

More
than
once a
day

Once a
day

More
than
once a
week

Once a
week

More
than
once a
month

Once a
month

Less
than
once a
month

Refused
to answer

.00.. 01…..02…..03…...04…… 05….....06…….07……77

In the past 12 months when you injected, did you get your needles at any of the following
places? [GIVE RESPONDENT FLASHCARD M; READ ALL CHOICES]
No

Yes

Refused Don’t
to answer know

a. Pharmacy or drug store ……... …………………………………..  0….  1…  7…. 9
b. Doctor’s office, clinic, or hospital……………………………......  0….  1…  7…. 9

 0….  1…  7…. 9
Needle or drug dealer, shooting gallery, hit house, off the street...  0….  1…  7…. 9
Needle exchange program………………………………………... 0…  1…  7…. 9
Some other place………………………………………………….  0…  1…  7…. 9

c. Friend, acquaintance, relative, or sex partner………………..…
d.
e.
f.

(Specify ___________________________)

ID-5.

In the past 12 months when you injected, how often did you use a new, sterile needle? By a
new, sterile needle, I mean a needle never used before by anyone, even you. [GIVE
RESPONDENT FLASHCARD N, READ CHOICES. CHECK only ONE.]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

SAY: Next, I'm going to ask you about your injecting behaviors in the past 12 months.

ID-6. In the past 12 months, with how many people did you use a needle after they injected with it?
[Refused = 777, Don't know = 999]

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ID-7.

In the past 12 months, with how many people did you use the same cooker, cotton, or water
that they had already used. By “water,” I mean water for rinsing needles or preparing drugs.
[Refused = 777, Don't know = 999]

ID-8.

__ __ __

In the past 12 months, with how many people did you use drugs that had been divided with a
syringe that they had already used?
[Refused = 777, Don't know = 999]

__ __ __

If ID-6≥ 1, ask ID-9

ID-9.

In the past 12 months, how often did you use needles that someone else had already injected
with? [GIVE RESPONDENT FLASHCARD N, READ CHOICES. CHECK only ONE]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

For NHBS-IDU, ask ID-10 through ID-12 then skip to ID-14
If ID-7 ≥ 1, ask ID-10– ID-12
ID-10.

In the past 12 months when you injected, how often did you use a cooker that someone else
had already used? [GIVE RESPONDENT FLASHCARD N, READ CHOICES, CHECK
only ONE.]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

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ID-11.

In the past 12 months when you injected, how often did you use a cotton that someone else
had already used? [GIVE RESPONDENT FLASHCARD N, READ CHOICES, CHECK
only ONE.]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

ID-12.

In the past 12 months when you injected, how often did you use water that someone else had
already used? [GIVE RESPONDENT FLASHCARD N, READ CHOICES, CHECK only
ONE]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

FOR NHBS-MSM AND NHBS-HET, ASK ID-13
If ID-7 ≥ 1, ask ID-13
ID-13.

In the past 12 months when you injected, how often did you use cookers, cottons, or water that
someone else had already used? [GIVE RESPONDENT FLASHCARD N, READ
CHOICES, CHECK only ONE.]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

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79

If ID-8 ≥ 1, ask ID-14
ID-14.

In the past 12 months when you injected, how often did you use drugs that had been divided
with a syringe that someone else had already injected with? [GIVE RESPONDENT
FLASHCARD N, READ CHOICES. CHECK only ONE.]
Never...….……….…….…………………..……  0
Rarely..….…………….……………….……..…  1
About half the time..……………………………  2
Most of the time….…..…..……..………………  3
Always…..….……………..……………………  4

7
Don’t know……………..………………………  9
Refused to answer……..………………………

If ID-6= 0, DK, or REF and
If ID-7= 0, DK, or REF and
If ID-8= 0, DK, or REF
then skip to the non-injection drug use section (ND)
SAY: Now I’d like you to think about the last time you injected with someone.
By “injecting with someone,” I mean you shared drugs or equipment, or both with at least one other person
that you were with when you injected.

ID-15.

When was the last time you injected with someone?
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

Y

Y

Y)

If ID-6=0, Skip to ID-17

ID-16.

The last time you injected with someone, did you use a needle after anyone else had already
injected with it?
No………………….……………………………  0
Yes……………………………………………...  1

Skip to ID-17

Refused to answer………………………………  7
Don't know…………..……………………...

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80

ID-16a.

Did you use a new sterile needle to inject?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If ID-7=0, Skip to ID-18

ID-17.

The last time you injected with someone, did you use a cooker, cotton, or water that anyone
else had already used?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If ID-8=0, Skip to ID-19

ID-18.

The last time you injected with someone, did you use drugs that had been divided with a
syringe that anyone else had already injected with?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

SAY: The next questions are about this last person you injected with.
ID-19.

Is this person male or female?

1
Female….…………………….……………..…  2
Other (specify______________)………………  3
Male………………………..…………..………

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81

ID-20.

As far as you know, has this person ever had sex with another man? Would you say he:
[READ CHOICES. Check only ONE.]
Definitely did not…………………….…………  0
Probably did not..………………………………
Probably did...………………………………
Definitely did ...………………….…………
Refused to answer…………………………..
Don't know.……………..………….………....

ID-21.

1
2
3
7
9

The last time you injected with this person, did you know their HIV status?
No………………….……………………………  0

Skip toID-22

Yes……………………………………………...  1
Refused to answer………………………………  7
ID-21a.

Skip to ID-22

What was their HIV status?
HIV-negative……………………………..…...... 1
HIV-positive…...….…………………..………..  2
Indeterminate……………………………..…….  3
Refused to answer.……………………………...  7

ID-22.

The last time you injected with this person, did you know if they had been tested for hepatitis
C?
No………………….……………………………  0

Skip to ID-23

Yes……………………………………………...  1
Refused to answer………………………………  7

ID-22a.

Skip to ID-23

What was the result of their hepatitis C test?
Negative.……………………………..…......  1
Positive...…...….…………………..………..  2
Refused to answer.………………………...
Don't know…………..………….………....

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9

82

ID-23.

Which of the following best describes you relationship to this person? Would you say this
person was a: [GIVE RESPONDENT FLASHCARD O. READ CHOICES, CHECK only
ONE.]

1
Friend or acquaintance ………………………  2
Relative ………………………………………  3
Needle or drug dealer…………………………..  4
Stranger..........................................……………..  5
Other (specify________________)…………….  6
Refused to answer………………...…………….  7
Don't know……………..……..…..…………..  9

Sex partner ……………………………….……

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83

Non-Injection Drug Use (ND)
SAY: Now I’m going to ask you about drugs that you may have used but did not inject. I will refer to these
as non-injection drugs. This includes drugs like marijuana, crystal meth, cocaine, crack, club drugs,
painkillers, or poppers.
ND-1.

In the past 12 months, have you used any non-injection drugs, other than those prescribed for
you?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If ES9=2 and ND-1 in (0, 7, 9), skip to Say Box before TX-1.
If ES9=1 and ND-1 in (0, 7, 9), skip to ND-3.
SAY: I'm going to read you a list of drugs. For each drug I mention, please tell me how often you used it in
the past 12 months. Do not include drugs you injected or drugs that were prescribed for you. GIVE
RESPONDENT FLASHCARD K.

ND-2.

How often did you use…READ EACH DRUG CHOICE. CHOOSE ONLY ONE RESPONSE
PER TYPE OF DRUG.

Never

More
than
once a
day

Once a
day

More
than
once a
week

a. Marijuana……………… 00……01…… 02……03…...
b. Crystal meth (tina, crank,
or ice)..…………………… 00……01…… 02……03…...
c. Crack cocaine……………....00……01….... 02……03…...
d. Powdered cocaine that is smoked
or snorted…………...…… 00……01…… 02…… 03…...
e. Downers such as Valium,
00……01…….02……03…...
Ativan, or Xanax.……
f. Painkillers such as Oxycontin,
Vicodin, or Percocet, .…
00……01…… 02……03…...
g. Hallucinogens such as LSD
or mushrooms……….…
00……01…… 02……03…...
h. X or Ecstasy…………….. 00……01…… 02……03…...
i. Heroin that is
smoked or snorted……..
00……01…… 02……03…...

Once a
week

More
than
once a
month

Once a
month

Less
than
once a
month

Refused
to answer

04……05…........ 06………07………77
04……05…........ 06…… 07………77
04……05…....... 06………07………77
04……05…........ 06………07………77
04……05…........ 06………07………77
04……05…........ 06………07………77
04……05…........ 06………07………77
04……05…........ 06………07………77
04……05…........ 06………07………77

If NHBS-MSM, ask ND-2j – ND-2l
j. Poppers ( amyl nitrate)...
k. GHB…………………
l. Special K (ketamine)……

00……01…… 02……03…... 04……05…........ 06………07………77
00……01……02……03…... 04……05…........ 06………07………77
00……01…… 02……03…... 04……05…........ 06………07………77

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84

ND-2m1. In the past 12 months have you used any other non-injection drugs?
No………………….……………………………  0

Skip to ND-3

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...
Specify other drug _____________________

Skip to ND-3

9

ND-2m2. How often did you use:

Never

m. (Other drug).

More
than
once a
day

Once a
day

More
than
once a
week

Once a
week

More
than
once a
month

Once a
month

Less
than
once a
month

Refused
to answer

.00.. 01…..02…..03…...04…… 05….....06…….07……77

If Respondent is not male (ES9 ≠ 1), skip to Say Box before TX-1.
ND-3.

In the past 12 months, have you used Viagra, Levitra or Cialis?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If TX-1 in (0, 7, 9), skip to Say Box before TX-1.
ND-3a.

Did you use it to treat erectile dysfunction?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If Respondent is male (ES9 =1) AND ID-3e or ND-2b are not 0 or 77, askND-3b. Otherwise, skip to
Say Box beforeTX-1.
ND-3b.

You told me that you used crystal meth (tina, crank, ice). In the past 12 months, did you use
Viagra, Levitra or Cialis at the same time you used crystal meth?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

9
85

ALCOHOL AND DRUG TREATMENT
SAY: Next, I’m going to ask you about alcohol and drug treatment programs. These include
out-patient, in-patient, residential, detox, methadone treatment, or 12-step programs.
TX-1.

Have you ever participated in an alcohol treatment program?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If TX-1=0, skip to TX-1b. If TX-1 in (7, 9), skip to TX-2.
TX-1a.

Have you participated in an alcohol treatment program in the past 12 months?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

TX-1b.

9

In the past 12 months, did you try to get into an alcohol treatment program but were unable to?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

TX-2.

9

Have you ever participated in a drug treatment program?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

9

If TX-2=0, skip to TX-2b. If TX-2 in (7, 9), skip to Say Box before HT-1

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TX-2a.

Have you participated in a drug treatment program in the past 12 months?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

TX-2b.

9

In the past 12 months, did you try to get into a drug treatment program but were unable to?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

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87

HIV TESTING EXPERIENCES
SAY: Now I’m going to ask you a few questions about getting tested for HIV. Remember, an
HIV test checks whether someone has the virus that causes AIDS.

HT-1.

Have you ever been tested for HIV?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7

9

Don't know…………..……………………...
If HT-1=0, skip to HT-6.
If HT-1 in (7, 9), Skip to Say Box before HT-9.

HT-2.

When did you have your first HIV test?
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

Y

Y Y)

CONF21. INTERVIEWER INSTRUCTIONS:
HIV testing was not widely available before 1985. Please confirm the year. Is &[TST1TSTY] correct?
Yes…………………………………………… 1 Go to next question
No……………………………………………  0 Loop back to put in the correct year
HT-3.

In the past 2 years, that is, since [insert calculated month and year], how many times have
you been tested for HIV?
___ ___ ___
[Refused = 777, Don't know = 999]

HT-4.

If 0, 777, or 999, skip to HT-4

When did you have your most recent HIV test?
[77/7777 = Refused, 99/9999 = Don't know] __ __/ __ __ __ __
(M M / Y

Y

Y

Y)

If Auto3 - HT-4 is > 5 years ago, skip to HT-4c.

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CONF22. INTERVIEWER INSTRUCTIONS:
HIV testing was not widely available before 1985. Please confirm the year. Is &[RCNTTSTY] correct?
Yes…………………………………………… 1 Go to next question
No……………………………………………  0 Loop back to put in the correct year

HT-4a.

When you got tested in ____/____ [insert date from HT-4], where did you get tested?
Testing Site:________________________________________________________
[Write down the site name and classify it from the list of choices below. Probe with additional questions if
necessary. DO NOT read choices. Choose only ONE site type.]
HIV counseling and testing site……..……………… ..... 01

 02
Drug treatment program………………..…………….…. 03
Needle exchange program.…...……..……………….  04
Correctional facility (jail or prison)………………….…  05
Family planning or obstetrics clinic……………..........  06
Public health clinic/ Community health center ………..  07
Private doctor’s office (including HMO)……………..  08
Emergency room………….……...…………………….  09
Hospital (inpatient)……………...….………………..…  10
At home…………..……………………………………  11
Other………..………………………….………………  12
Refused………………………………………...............  77
Don’t know……….....……..…………………….........  99
HIV/AIDS street outreach program/Mobile Unit…

HT-4b.

When you got tested in ____/____ [insert date fromHT-4], was it a rapid test where you could
get your results within a couple of hours?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

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89

HT-4c.

What was the result of your most recent HIV test? [DO NOT Read choices, check only ONE.]
Negative…………….………………….…………………..
Positive………………………….……………….…..........
Never obtained results……………………………...….......
Indeterminate…………..……………..……………………
Refused to answer…………...….…………………………..
Don't know…...…………………………............................

1
2
3
4
7
9

If HT-4c=1, go to Logic check before HT-6. If HT-4c=2, skip to HT-7.
If HT-4c in (7, 9), go to Logic Check before HT-6.
HT-5.

Before your test in ____/_____ [insert date fromHT-4], did you ever test positive for HIV?
No………………….……………………………  0
Yes……………………………………………...  1

Skip to HT-7a

Refused to answer………………………………  7
Don't know…………..……………………...

9

INTERVIEWER INSTRUCTIONS: Refer to HT-4. LAST HIV TEST WAS DONE (Check one):
< 12 months ago...................................
SAY Box before HT-9
> 12 months ago...................................
Go to next question
Date of last test Don't know/Refused…
Go to SAY Box before HT-9

[PERSONS WHO HAVE NEVER TESTED HIV+ AND HAVE NOT TESTED FOR
HIV IN THE PAST 12 MONTHS]
HT-6.

I’m going to read you a list of reasons why some people have not been tested for HIV. Which
of these best describes the most important reason you have not been tested for HIV in the past
12 months? [READ CHOICES. CHOOSE only ONE. ]
You think you are at low risk for HIV infection?………  1
You were afraid of finding out that you had HIV?..……  2
You didn’t have time?................................……………
Some other reason?........................................…………
No particular reason…...................................…………
Refused to answer.......................................…………
Don’t know…...................................…………

3
4
5
7
9

If HT-6 ≠ 4, go to Say Box before HT-9.
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HT-6a.

What was the most important reason you have not been tested for HIV in the past 12 months?
_______________________________________________

Go to Say Box before HT-9.

[PERSONS WHO HAVE TESTED HIV POSITIVE]
HT-7.

Was your test in ____/_____ [insert date from HT-4] your first positive test?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………...

HT-7a.

Skip to HT-7b

9

When did you first test positive?
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

Y

Y Y)

CONF23. INTERVIEWER INSTRUCTIONS:
HIV testing was not widely available before 1985. Please confirm the year. Is &[POS1STDY] correct?
Yes……………………………………… 1 Go to next question
No………………………………………  0 Loop back to put in the correct year

HT-7b.

After you tested positive, were you asked by someone from the health department or your
health care provider to give the names of your sex or drug use partners so they could be
notified that they may have been exposed to HIV?
No…….……………….……………………………  0
Yes…..……………………………………………...  1
Refused to answer…..………………………………  7
Don't know…………………..……………………...  9

If HT-7b in (0, 7, 9), skip to HT-7d.

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HT-7c.

Did you give the names or contact information of any of your partners when asked?
No…….……………….……………………………
Yes…..……………………………………………...
Refused to answer…..………………………………
Don't know…………………..……………………...

HT-7d.

0
1
7
9

Before your first positive test in _____ / ______ [insert date from HT-4 or HT-7a], did you
ever have a negative HIV test? (By negative HIV test, I mean the test showed you did not
have HIV infection.)
No…….……………….……………………………
Yes…..……………………………………………...
Refused to answer…..………………………………
Don't know…………………..……………………...

0
1
7
9

If HT-7d in (0, 7, 9), skip to HT-7e.

HT-7d.1

What was the month and year that you got your last negative HIV test? Tell me when you got
your last test, not when you got your results.
[77/7777 = Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

HT-7e.

Y

Y)

In the 2 years before your first positive test in _____ / ______ [insert date from HT-4 or HT7a], how many times did you get tested for HIV? Don't include your first positive test in that
total number.
[Refused = 7777, Don't know = 9999]

HT-7f.

Y

___ ___ ___ ___

Have you ever been seen by a doctor, nurse, or other health care provider for a medical
evaluation or care related to your HIV infection?
No…….……………….……………………………
Yes…..……………………………………………...
Refused to answer…..………………………………
Don't know…………………..……………………...

0
1
7
9

If HT-7f = 1, skip to HT-7g.
If HT-7f in (7, 9), skip to Say Box before HT-8b.
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HT-7f.1.

What is the main reason you have never gone to a health care provider for a medical
evaluation or care related to your HIV infection? [DO NOT read choices. Choose only ONE reason.]
Feel good, don't need to go …………………..……………………
Don't want to think about being HIV positive/Denial……………
Didn’t have money or insurance…..………….……………………..
Inconvenient (location/hours/time, etc.)....…………………………
Forgot to go/Missed appointment……………..……………………
Drinking or using drugs………….……………...............................
Appointment pending..………..…………………………………
Other……………………..…………………………………………
Refused.…………………………………………………………
Don’t know……………………..…………………........................

 01
 02
 03
 04
 05
 06
 07
 08
 77
 99

If HT-7f.1=8, ask HT-7f.2. Otherwise, skip to Say Box before HT-8b.

HT-7f.2.

Interviewer: Type in other reason Respondent never sought HIV care.
_____________________

Skip to Say Box before HT-8b.

HT-7g.

When did you first go to your health care provider after learning you had HIV?
[77/7777=Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

Y

Y

Y)

INTERVIEWER INSTRUCTIONS: Refer to date of first positive HIV test (HT-4or HT-7a)
< 3 months before first provider visit
Skip to HT-7i
> 3 months before first provider visit
Go to next question
Interval cannot be determined (date missing)
Skip to HT-7i

If first positive test result was > 3 years before [date of interview], skip to HT-7i

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HT-7h.

Some people go to a health care provider soon after learning they are positive; others do not.
What is the main reason you didn’t go to a health care provider soon after you learned of your
HIV infection? [DO NOT read choices. Choose only ONE reason.]
Felt good, didn't need to go ……..…………………..…………………  01
Didn't want to think about being HIV positive/Denial…………………  02

 03
Inconvenient (location/hours/time, etc.)…....………………………….  04
Forgot to go/Missed appointment………….………..…………………  05
Drinking or using drugs……………...……………................................  06
Unable to get an earlier appointment……….…………………………  07
Other…….…………………..………………………………………….  08
Refused…………………………………………………………………  77
Don’t know…..……………………..…………………..........................  99
Didn’t have money or insurance……..………….……………………..

If HT-7h = 8, ask HT-7h.1. Otherwise, go to HT-7i.

HT-7h.1

Interviewer: Type in other reason Respondent did not seek HIV care soon after diagnosis:
_________________________________

HT-7i.

When did you last go to your health care provider for HIV care?
[77/7777=Refused, 99/9999 = Don't know]

__ __/ __ __ __ __
(M M / Y

INTERVIEWER INSTRUCTIONS:
< 6 months since last provider visit
> 6 months since last provider visit
Interval cannot be determined (date missing)

HT-7j.

Y

Y

Y)

Skip to HT-8
Go to next question
Skip to HT-8

What is the main reason you have not gone to a health care provider for HIV care in the
past 6 months? [DO NOT Read reason types. Choose only ONE reason.]
Felt good, didn't need to go…………………………..…………………  01
Don't want to think about being HIV positive/Denial…….……………  02

 03
Inconvenient (location/hours/time, etc.).........…………………………  04
Forgot to go/Missed appointment…….…………..……………………  5
Didn’t have money or insurance….…..………….…………………….

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Drinking or using drugs……..……….……………................................  06
Appointment pending…….….…………………………………………  07
Other……………….………..………………………………………….  08
Refused…………………………………………………………………  77
Don’t know……...………………..…………………..........................

 99

If HT-7j = 8, ask HT-7j.1. Otherwise, go to HT-8.

HT-7j.1.

Interviewer: Type in other reason Respondent has not sought HIV care in past 6 months:
_________________________________

HT-8.

Are you currently taking antiretroviral medicines to treat your HIV infection?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HT-8 in (1, 7, 9), skip to Say Box before HT-8b.

HT-8a.

What is the main reason you are not currently taking any antiretroviral medicines? [DO NOT
read reason types. Choose only ONE reason.]
Feel good, don’t need them……….......……..………………….  01
CD4 count and viral load are good……….……….....................  02
Doctor advised to delay treatment…………..………….............  03
Don't want to think about being HIV positive./Denial…………  04
Worried about side effects …………..………..…….….............  05
Don't have money or insurance……………….…………....…..  06
Drinking or using drugs…………………..…..…….…………..  07

 08
Other……………………………..……………………..............  09
Refused…………………………………………………………  77
Don’t know……………………………….……………….........  99
Recently into medical care……..……………………………...

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If HT-8a = 9, ask HT-8a.1. Otherwise, go to Say Box before HT-8b.
HT-8a.1

SAY:

HT-8b.

Interviewer: Type in other reason Respondent is not currently taking ARVs:
____________________________

Researchers are studying whether antiretroviral medicines could possibly be taken to prevent HIV
infection.
Before today, have you ever heard of people who do not have HIV taking antiretroviral
medicines, to keep from getting HIV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HT-8 ≠ 1 OR HT-8b in (0, 7), skip to Say Box before HT-14.
HT-8c.

In the past 12 months, have you given your antiretroviral medicines to a sex partner who was
HIV-negative because you thought it might keep them from getting HIV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

Skip to SAY Box before HT-14

FOR PARTICIPANTS WHO HAVE NOT PREVIOUSLY TESTED HIV+:
SAY:

HT-9.

Researchers are studying whether anti-HIV medicine (also called antiretrovirals)-- a pill -- could
possibly be taken to prevent HIV infection.
Before today, have you ever heard of people who do not have HIV taking anti-HIV medicines,
to keep from getting HIV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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If HT-9 in (0, 7), skip to HT-13.
HT-10.

In the past 12 months, have you taken anti-HIV medicines after sex because you thought it
would keep you from getting HIV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HT-11.

In the past 12 months, have you taken anti-HIV medicines before sex because you thought it
would keep you from getting HIV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If participant has not taken PEP or PrEP in the past 12 months, skip to HT-14.

HT-12.

Please tell me if you got any of the anti-HIV medicines you took from the following people or
places. Did you get them from…[GIVE RESPONDENT FLASHCARD P. READ ALL
CHOICES.]
a.
b.
c.
d.

Doctor or other health care provider
Sex partner, friend, relative, or acquaintance
Internet
Some other place (Specify ______________)

HT-12d.1. Interviewer: Type in other specified place

HT-13.

No

Yes

Refused
to answer

Don’t
know

0
0
0
0

1
1
1
1

7
7
7
7

9
9
9
9

______________________________.

Would you be willing to take anti-HIV medicines every day to lower your chances of getting
HIV?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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FOR ALL PARTICIPANTS:
SAY:

Now I’m going to read you some statements. Please tell me how strongly you agree or disagree
with each statement, using the options on this card. [Give participant Flashcard G ]

HT-14.

The first statement is… Most people in [project area] would discriminate against someone with
HIV. Do you…[Read choices. Mark only one.]
Strongly agree..……………......……..…………  01

 02
Neither agree nor disagree…….…..…..……….  03
Disagree…………….……………………….…  04
Strongly disagree…………… …..…….............  05
Refused to answer…….…………………….…  07
Don’t know……..…..…… …..……….............  09
Agree……………………………………...........

HT-15.

Most people in [project area] would support the rights of a person with HIV to live and work
wherever they wanted to. Do you…[Read choices. Mark only one.]
Strongly agree..……………......……..…………  01

 02
Neither agree nor disagree…….…..…..……….  03
Disagree…………….……………………….…  04
Strongly disagree…………… …..…….............  05
Refused to answer…….…………………….…  07
Don’t know……..…..…… …..……….............  09
Agree……………………………………...........

HT16.

Most people in [project area] would not be friends with someone with HIV. Do you…[Read
choices. Mark only one.]
Strongly agree..……………......……..…………  01

 02
Neither agree nor disagree…….…..…..……….  03
Disagree…………….……………………….…  04
Strongly disagree…………… …..…….............  05
Refused to answer…….…………………….…  07
Don’t know……..…..…… …..……….............  09
Agree……………………………………...........

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HT-17.

Most people in [project area] think that people who got HIV through sex or drug use have
gotten what they deserve. Do you…[Read choices. Mark only one.]
Strongly agree..……………......……..…………  01

 02
Neither agree nor disagree…….…..…..……….  03
Disagree…………….……………………….…  04
Strongly disagree…………… …..…….............  05
Refused to answer…….…………………….…  07
Don’t know……..…..…… …..……….............  09
Agree……………………………………...........

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HEALTH CONDITIONS (HC)
SAY:

Next, I'd like to ask you some questions about your health.

If Respondent is Male (ES9 =1), ask HC-1
HC-1.

Have you been circumcised?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

SAY:

HC-2.

The next questions are about hepatitis, an infection of the liver.

Has a doctor, nurse or other health care provider ever told you that you had hepatitis?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-2a.

Skip to HC-5

Skip to HC-5

What type or types of hepatitis have you had? [CHECK ALL THAT APPLY.]
Hepatitis A……….…………………………….
Hepatitis B………………….………….............
Hepatitis C……………………………..............
Other……………..…………….………………
If Other: Specify__________________

0
1
2
3

Refused to answer………………………………  7
Don't know……………..……………...............

9

If HC-2a in (0, 3, 7, 9), skip to HC-5.
If participant reports history of hepatitis B infection (HC-2a=1), ask HC-3.
If participant reports history of hepatitis C infection (HC-2a=2), ask HC-4a thru HC-4c).

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HC-3.

Have you ever taken medicine to treat your hepatitis B infection?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-4a.

When were you told you had hepatitis C? [READ CHOICES. CHECK ONE.]

0
More than 6 months, but less than 1 year ago.…….
1
2
At least 1 year but less than 5 years ago ………
At least 5 years but less than 10 years ago……..………  3
10 years ago or more…...……………..……………….  4
Refused to answer…………………..…………………  7
Don't know……………..…………...…………………  9
6 months ago or less.………………………………….

HC-4b.

Have you ever taken medicine to treat your hepatitis C infection?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-4b= 0, 7, OR 9, skip to HC-5.

HC-4c.

Did your doctor tell you that you were cured of your hepatitis C infection after you finished
taking medicine for hepatitis C?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

SAY:

Now I'm going to ask you about getting tested for hepatitis.

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HC-5.

Have you ever had a blood test to check for hepatitis C infection?
No………………….…………………………… 0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-5 in (0, 7, 9), skip to HC-5b.

HC-5a.

When did you have your most recent hepatitis C test? [READ CHOICES. CHECK only
ONE]
6 months ago or less……..…………………..…  0
More than 6 months ago, but less than 1 year….  1

2
Refused to answer…..…………………..………  7
Don't know….……………..…………...………  9
1 year ago or more……………………………

HC-5b.

Have you ever had a blood test to check for for hepatitis B?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-5b in (0,7,9), skip to HC-6.

HC-5c.

When did you have your most recent hepatitis B test? [READ CHOICES. CHECK only
ONE]
6 months ago or less.…………………..………
More than 6 months ago, but less than 1 year…
1 year ago or more……………………………
Refused to answer…………………..…………
Don't know……………..…………...…………

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0
1
2
7
9

102

HC-6.

There are vaccines or shots that can prevent some types of hepatitis. Have you ever had a
hepatitis vaccine?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-6a.

Skip to
Say box before HC-7
Skip to
Say box before HC-7

What type or types of hepatitis vaccine have you had? [READ CHOICES. CHECK only
ONE]
Hepatitis A vaccine..…………………………
Hepatitis B vaccine……………………………
Both Hepatitis A and B vaccines……………
Refused to answer..………………..…………
Don't know………………..…………..............

1
2
3
7
9

SAY: Now, I’m going to ask you some questions about sexually transmitted diseases, or STDs, other than
HIV and hepatitis.
HC-7.

Has a doctor or other health care provider ever told you that you had genital herpes?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-8.

Has a doctor or other health care provider ever told you that you had genital warts?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-9.

Has a doctor or other health care provider ever told you that you had human papillomavirus or
HPV?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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HC-10.

In the past 12 months, that is, since (__/____), were you tested by a doctor or other health care
provider for a sexually transmitted disease like gonorrhea, chlamydia, or syphilis? Do NOT
include tests for HIV or hepatitis.
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-10 = 0, skip to HC-12.

HC-11.

In the past 12 months, that is, since (__/____), were you tested for… [READ choices. CHECK
YES or NO for each one.]
No

Yes

Refused
to answer

 0......…  1……..
b. Chlamydia?…………....................  0......…  1……..
c. Syphilis?…………… ……………  0........  1…….
d. Some other STD (except HIV)?….  0......…  1……..
a. Gonorrhea?…………..…………..

Don’t
Know

 7………… 9
 7……..….. 9
 7……..….. 9
 7……..….. 9

d.1 If Yes: Specify__________________

HC-12.

In the past 12 months, has a doctor or other health care provider told you that you had
gonorrhea?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-13.

In the past 12 months, has a doctor or other health care provider told you that you had
Chlamydia?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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104

HC-14.

In the past 12 months, has a doctor or other health care provider told you that you had syphilis?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

HC-15.

In the past 12 months, has a doctor or other health care provider told you that you had any
other sexually transmitted disease?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-15 =0, skip to HC-16

HC-15a.

What was that other STD? ____________________

If participant was ever diagnosed with HPV (HC-9= 1), skip to JT-1.

HC-16.

A vaccine to prevent HPV infection is available and is called the HPV shot, cervical cancer
vaccine, GARDASIL®, or CERVARIX®. Have you ever received the HPV shot or cervical
cancer vaccine?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If HC-16 in (0, 7, 9), skip to JT-1.

HC-17.

How old were you when you received your first dose of the HPV vaccine?
[77= Refused, 99= Don’t know]

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105

HIV TESTING IN JAIL (JT)
SAY: Now I will ask about experiences you may have had with the criminal justice system. Please
remember your answers will be kept private.

JT-1.

Have you ever been held in a detention center, jail, or prison for more than 24 hours?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

JT-1a.

Skip to Say Box PA-1

Skip to Say Box PA-1

During the past 12 months, have you been held in a detention center, jail, or prison, for more
than 24 hours??
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If JT-1a in (0, 7, 9), skip to Say Box before PA-1.

JT-2.

During the past 12 months, when you were in detention, jail, or prison, did you get a test for
HIV?
No………………….……………………………  0

Skip to JT-3

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

JT-2a.

Skip to JT-3

During the past 12 months, how many times did you get tested for HIV in detention, jail, or
prison?
[77 = Refused, 99 = Don't know]

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106

JT-2b.

[If JT-2a > 1 and < 77, autofill with “Think of the last time you were tested for HIV in
detention, jail, or prison.”] Did you get the results of that HIV test?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

JT-3.

During the past 12 months, when you were in detention, jail, or prison, did you get a test for
hepatitis C?
No………………….……………………………  0

Skip to Say Box before PA-1

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

JT-3a.

During the past 12 months, how many times did you get tested for hepatitis C in detention,
jail, or prison?
[77 = Refused, 99 = Don't know]

JT-3b.

Skip to Say Box before PA-1

__ __

[If JT-3a > 1 and < 77, autofill with “Think of the last time you were tested for hepatitis C in
detention, jail, or prison.”] Did you get the results of that hepatitis C test?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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ASSESSMENT OF PREVENTION ACTIVITIES (PA)
SAY: Next I'd like to ask you about HIV prevention activities that happen around here.
PA-1.

In the past 12 months, have you gotten any free condoms, not counting those given to you by a
friend, relative, or sex partner?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If PA-1 in (0, 7, 9) AND participant injected in past 12 months, skip to PA-2.
Else, if PA-1 in (0, 7, 9) AND participant did NOT inject in past 12 months, skip to PA-4.
If PA-1=1AND NHBS-MSM, go to PA-1a.
Else, if PA-1=1 AND NHBS-IDU, skip to PA-1b.
Else if PA-1=1 AND NHBS-HET, skip to PA-1c.

PA-1a.

[GIVE RESPONDENT FLASHCARD Q.] Which place or places on this list did you get free
condoms from? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
GLBTQ organization or community health center……
Health center or clinic……………………….………
Bar, club, bookstore, or other business..……………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

1
2
3
4
5
7
9

Skip to PA-1d.

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PA-1b.

[GIVE RESPONDENT FLASHCARD R.] Which place or places on this list did you get free
condoms from? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
Needle or syringe exchange program……………….
IDU outreach program……………………….………
Health center or clinic………………...………………
Drug or alcohol treatment program……………………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

1
2
3
4
5
6
7
9

Skip to PA-1d.

PA-1c.

[GIVE RESPONDENT FLASHCARD S.] Which place or places on this list did you get free
condoms from? [READ CHOICES. MARK ALL THAT APPLY.]

1
Health center or clinic………………………….………  2
Bar, club, bookstore, or other business…..……………  3
Drug or alcohol treatment program……………………  4
Some other place………………………………………  5
Refused to answer..……………………….…...............  7
Don’t know….………..………….……………………  9
HIV/AIDS-focused community-based organization..…

PA-1d.

Have you used any of the free condoms you received?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If injected drugs in past 12 months, go to PA-2. Otherwise, skip to PA-4.

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PA-2.

In the past 12 months, have you gotten any new sterile needles for free, not including those
given to you by a friend, relative, or sex partner?
No………………….……………………………  0

Skip to PA-3

Yes……………………………………………...  1
Refused to answer………………………………  7

Skip to PA-3

Don't know…………..……………………... ….  9

PA-2a.

[GIVE RESPONDENT FLASHCARD R.] Which place or places on this list did you get the
free sterile needles from? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
Needle or syringe exchange program……………….
IDU outreach program……………………….………
Health center or clinic………………...………………
Drug or alcohol treatment program……………………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

PA-2b.

1
2
3
4
5
6
7
9

Have you used any of the free sterile needles you received?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

PA-3.

In the past 12 months, have you gotten any new cookers, cotton, or water for free, not
including those given to you by a friend, relative, or sex partner?
No………………….……………………………  0

Skip to PA-4

Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

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Skip to PA-4

110

PA-3a.

[GIVE RESPONDENT FLASHCARD R.] Which place or places on this list did you get
those free items from? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
Needle or syringe exchange program……………….
IDU outreach program……………………….………
Health center or clinic………………...………………
Drug or alcohol treatment program……………………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

PA-3b.

1
2
3
4
5
6
7
9

Have you used the free cookers, cotton, or water that you received?
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

PA-4.

In the past 12 months, have you had a one-on-one conversation with an outreach worker,
counselor, or prevention program worker about ways to prevent HIV? Don’t count the times
when you had a conversation as part of an HIV test.
No………………….……………………………  0

Skip to PA-5

Yes……………………………………………...  1
Refused to answer………………………………  7

Skip to PA-5

Don't know…………..……………………... ….  9
If PA-4 in (0, 7, 9), skip to PA-5.
If PA-4=1AND NHBS-MSM, go to PA-4a.
Else, if PA-4=1 AND NHBS-IDU, skip to PA-4b.
Else if PA-4=1 AND NHBS-HET, skip to PA-4c.

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PA-4a.

[GIVE RESPONDENT FLASHCARD Q.] Which type of organization did they work for?
[READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
GLBTQ organization or community health center……
Health center or clinic……………………….………
Bar, club, bookstore, or other business..……………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

1
2
3
4
5
7
9

Skip to PA-4d.

PA-4b.

[GIVE RESPONDENT FLASHCARD R.] Which type of organization did they work for?
[READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
Needle or syringe exchange program……………….
IDU outreach program……………………….………
Health center or clinic………………...………………
Drug or alcohol treatment program……………………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

1
2
3
4
5
6
7
9

Skip to PA-4d.
PA-4c.

[GIVE RESPONDENT FLASHCARD S.] Which type of organization did they work for?
[READ CHOICES. MARK ALL THAT APPLY.]

1
Health center or clinic………………………….………  2
Bar, club, bookstore, or other business…..……………  3
Drug or alcohol treatment program……………………  4
Some other place………………………………………  5
Refused to answer……………………….…...............  7
Don’t know…………..………….……………………  9
HIV/AIDS-focused community-based organization..…

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PA-4d.

During those one-on-one conversation(s), did you: [ASK EACH QUESTION, MARK NO
OR YES FOR EACH]
No
Yes Refused Don't
to answer Know

1. Discuss ways to talk to a partner about safe sex?....
If yes, ask:

 0…  1 …  7………. 9

2. Practice ways to talk to a partner about safe sex?........  0....  1…
3. Discuss ways to effectively use condoms?…...……..
If yes, ask:

 7………. 9

 0…  1…  7………. 9

4. Practice ways to effectively use condoms?.................. 0…  1….. 7………. 9
[If injected drugs in past 12 months, ask:]
5. Discuss how to prepare for safe injections?…...…….  0… 1….. 7………. 9
If yes, ask:
6. Practice safe drug-injecting practices?……….....…… 0… 1….. 7………. 9
PA-5.

In the past 12 months have you been a participant in any organized session(s) involving a
small group of people to discuss ways to prevent HIV? Don't include discussions you had
with a group of friends.
No………………….……………………………  0
Yes……………………………………………...  1
Refused to answer………………………………  7
Don't know…………..……………………... ….  9

If PA-5 in (0, 7, 9), skip to INT11.
If PA-5=1 AND NHBS-MSM, go to PA-5a.
Else, if PA-5=1 AND NHBS-IDU, skip to PA-5b.
Else if PA-5=1 AND NHBS-HET, skip to PA-5c.
PA-5a.

[GIVE RESPONDENT FLASHCARD Q.] Which type of organization sponsored those
sessions? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
GLBTQ organization or community health center……
Health center or clinic……………………….………
Bar, club, bookstore, or other business..……………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

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1
2
3
4
5
7
9
113

Skip to PA-5d.

PA-5b.

[GIVE RESPONDENT FLASHCARD R.] Which type of organization sponsored those
sessions? [READ CHOICES. MARK ALL THAT APPLY.]
HIV/AIDS-focused community-based organization…
Needle or syringe exchange program……………….
IDU outreach program……………………….………
Health center or clinic………………...………………
Drug or alcohol treatment program……………………
Some other place ……………………………………
Refused to answer……………………….…...............
Don’t know…………..………….……………………

1
2
3
4
5
6
7
9

Skip to PA-5d.

PA-5c.

[GIVE RESPONDENT FLASHCARD S.] Which type of organization sponsored those
sessions? [READ CHOICES. MARK ALL THAT APPLY.]

1
Health center or clinic………………………….………  2
Bar, club, bookstore, or other business…..……………  3
Drug or alcohol treatment program……………………  4
Some other place………………………………………  5
Refused to answer……………………….…...............  7
Don’t know…………..………….……………………  9
HIV/AIDS-focused community-based organization..…

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PA-5d.

During those organized group session(s), did you: [ASK EACH QUESTION, MARK NO
OR YES FOR EACH.]
No

1. Discuss ways to talk to a partner about safe sex?....
If yes, ask:

Yes

 0…  1 …  7………. 9

2. Practice ways to talk to a partner about safe sex?........  0....  1…
3. Discuss ways to effectively use condoms?…...……..
If yes, ask:

Refused Don't
to answer Know

 7………. 9

 0…  1…  7………. 9

4. Practice ways to effectively use condoms?..................  0…  1…

 7………. 9

[If injected drugs in past 12 months, ask:]
5. Discuss how to prepare for safe injections?…...…….  0… 1…
If yes, ask:

 7………. 9

6. Practice safe drug-injecting practices?……….....…… 0… 1…

 7………. 9

BEFORE BEGINNING THE LOCAL QUESTIONS, THE INTERVIEWER ANSWERS THE
FOLLOWING QUESTION. DO NOT READ THIS QUESTION TO THE RESPONDENT.
INT11. How confident are you of the validity of the respondent’s answers?
Confident….…………………..………………  1

2
Not confident at all…………………..…..........  3

Some doubts………………………..…………

If response is 2 or 3, please explain why you are not confident in the respondent's answers:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Auto8.

Time core questionnaire ended: __ __:__ __

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115

INTERVIEWER INSTRUCTIONS:
Please confirm. Did the person complete the survey?
No (did not complete the survey)……………………………… 0
Yes (did complete the survey)…………………………………..  1
If consent for HIV test not recorded (CN-2 = 0), go to CONF23.
CONF23. INTERVIEWER INSTRUCTIONS:
SAY: My records reflect that you did not agree to HIV testing when asked earlier during the interview.
Before I close out the survey, I’d like to ask you again about whether or not you would like an HIV test.
Did you want the HIV test that is part of today’s survey?
Yes (respondent DOES want the test)…………………….… 1
No (respondent DOES NOT want the test)……………...….  0
If CONF23 =1, go to INT12.
INT12. Interviewer Instructions:
Indicate each activity the participant consents to. CHECK ALL THAT APPLY
 HIV testing and counseling
 Having other lab tests (if offered)
 Storing a blood specimen for future testing

FOR NHBS-IDU
Message about Eligibility to Receive Coupons:
If COMPLETE=1 AND VALIDITY ≠ 3:
"This respondent is ELIGIBLE to recruit others and receive coupons."
Message about not being eligible to receive coupons:
If VALIDITY = 3 OR COMPLETE=0:
“This respondent is NOT eligible to recruit others or receive coupons.”

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FOR NHBS-HET
Message about Eligibility to Receive Coupons:
Non-seeds:
If participant met HET definition {at/below poverty OR low education AND gender=male or female
AND no IDU in past 12 mos.}, AND COMPLETE=1 AND (VALIDITY =1 or 2);
Seeds:
If participant met recruiter criteria for non-seed AND HRA=1 AND EVRINJ=0;
"This respondent is ELIGIBLE to recruit others and receive coupons."
Message about not being eligible to receive coupons:
Non- seeds:
If participant did NOT meet HET definition OR VALIDITY = 3 OR COMPLETE = 0
Seeds:
If participant did NOT meet HET definition OR VALIDITY = 3 OR COMPLETE = 0 OR participant
does NOT live in an HRA OR participant ever injected;
“This respondent is NOT eligible to recruit others or receive coupons.”

To the Interviewer: Do you have any additional comments to add?
If yes, enter comments below:
Interviewer Comments

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117

LOCAL USE QUESTIONS FOLLOW

After completing the local questions say:
Do you have any questions about the issues we've talked about?

Thank the respondent for their time and end the interview.

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National HIV Behavioral Surveillance System: Flashcards

FLASHCARD A
 American Indian or Alaska Native
 Asian
 Black or African American
 Native Hawaiian or Other Pacific Islander
 White

FLASHCARD B.1


A relative or family member



A person you have sex with



A person you use drugs with or buy drugs from



A friend



An acquaintance



A stranger

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119

FLASHCARD B.2
 A relative or family member
 A person you have sex with
 A friend
 An acquaintance
 A stranger

FLASHCARD C

How many people do you know who are:
 Friends, relatives, or other people you are close to, AND
 Who are at least 18 years old, AND
 Who live in [insert project area]

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120

FLASHCARD D


Married



Living together as married



Separated



Divorced



Widowed



Never married

FLASHCARD E

MONTHLY INCOME

A. $0 to $417
B. $418 to $833
C. $834 to $1,041
D. $1,042 to $1,250
E. $1,251 to $1,667
F. $1,668 to $2,082
G. $2,083 to $2,500
H. $2,501 to $2,916
I. $2,917 to $3,333
J. $3,334 to $4,167
K. $4,168 to $4,999
L. $5,000 to $6,250
M. $6,251 or more

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OR

YEARLY INCOME

A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.

$0 to $4,999
$5,000 to $9,999
$10,000 to $12,499
$12,500 to $14,999
$15,000 to $19,999
$20,000 to $24,999
$25,000 to $29,999
$30,000 to $34,999
$35,000 to $39,999
$40,000 to $49,999
$50,000 to $59,999
$60,000 to $74,999
$75,000 or more

121

FLASHCARD F
Insurance Coverage
 Private health plan
 Medicaid / [insert local Medicaid name]
 Medicare
 Other Medical Assistance program [insert local Non-Medicaid
public health plan name]
 TRICARE (CHAMPUS)
 Veterans Administration coverage
 Some other health care plan

FLASHCARD G

 Strongly agree
 Agree
 Neither agree nor disagree
 Disagree
 Strongly disagree
 

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FLASHCARD H.1

Definition of "Having Sex"

Oral, vaginal, or anal sex.
 Oral sex means mouth on the vagina or penis


Vaginal sex means penis in the vagina

 Anal sex means penis in the anus (butt)
 

FLASHCARD H.2

Definition of "Having Sex"

Oral or anal sex.
 Oral sex means mouth on the penis
 Anal sex means penis in the anus (butt)
 

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123

FLASHCARD I

Female Sex Partners
Main partner:
A woman you have sex with and who you feel committed to above anyone
else. This is a partner you would call your girlfriend, wife, significant other,
or life partner.

Casual partner:
A woman you have sex with but do not feel committed to or don't know
very well.

FLASHCARD J

Male Sex Partners
Main partner:
A man you have sex with and who you feel committed to above anyone else.
This is a partner you would call your boyfriend, husband, significant other,
or life partner.

Casual partner:
A man you have sex with but do not feel committed to or don't know very
well.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

124

FLASHCARD K

0. Never
1. More than once a day
2. Once a day
3. More than once a week
4. Once a week
5. More than once a month
6. Once a month
7. Less than once a month

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

125

FLASHCARD L
FOR USE WITH ALCOHOL QUESTIONS

1 Shot of Liquor
(Whisky, Vodka, Gin, etc.)
1.5 oz.

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

1 Regular Beer
12 oz.

1 Glass of Wine
5 oz.

126

FLASHCARD M

a. Pharmacy or drug store
b. Doctor’s office, clinic, or hospital
c. Friend, acquaintance, relative, or sex partner
d. Needle or drug dealer, shooting gallery, hit house, off the street
e. Needle exchange program

FLASHCARD N

0. Never
1. Rarely
2. About half the time
3. Most of the time
4. Always

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

127

FLASHCARD O

0. Sex partner
1. Friend or acquaintance
2. Relative
3. Needle or drug dealer
4. Stranger

FLASHCARD P

 Doctor or other health care provider
 Sex partner, friend, relative, or acquaintance
 Internet
 Some other place

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

128

FLASHCARD Q

 HIV/AIDS-focused community-based organization
 GLBTQ organization or community health center
 Health center or clinic
 Bar, club, bookstore, or other business
 Some other place

FLASHCARD R

 HIV/AIDS-focused community-based organization
 Needle or syringe exchange program
 IDU outreach program
 Health center or clinic
 Drug or alcohol treatment program
 Some other place

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

129

FLASHCARD S

 HIV/AIDS-focused community-based organization
 Health center or clinic
 Bar, club, bookstore, or other business
 Drug or alcohol treatment program
 Some other place

NHBS Round 3 Questionnaire, v. 11 - Clean
December 20, 2010

130